Use of DSM-III axis IV in clinical practice: Rating the severity of psychosocial stressors

This study investigates the usefulness of DSM-III Axis IV ratings of Severity of Psychosocial Stressors. Multiaxial evaluations were made on a diagnostically heterogeneous group of 362 psychiatric patients. Severity ratings on Axis IV were compared to a more extensive system for measuring life event stress, embedded in the Psychiatric Epidemiology Research Interview (PERI). The results indicate that Axis IV ratings are consistent with meaningful diagnostic and demographic group differences, and correlate significantly with PERI ratings of normative change or disruption associated with rated events. The Axis IV guideline that the stressor reflect the summed effect of all psychosocial stressors listed, however, appeared to be too complex to be incorporated into routine clinical practice, even by relatively well-trained evaluators with expert supervision.