Skodol A E
Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY.
Compr Psychiatry. 1991 Nov-Dec;32(6):503-15. doi: 10.1016/0010-440x(91)90029-c.
DSM-III axis IV, Severity of Psychosocial Stressors, has been a disappointment to many because of the apparently infrequent use of the axis in clinical and research settings. This report is a review of literature on the use, reliability, and validity of axis IV. Although the concept of multiaxial evaluation has considerable appeal, clinicians have not routinely used axis IV, possibly because they do not fully understand the complexities involved in making ratings. The relatively few published empirical studies on axis IV indicate modest reliability and limited validity, beyond the value in identifying severe psychosocial stressors for the purpose of planning clinical interventions. The results of this review have led the DSM-IV Multiaxial Issues Work Group to consider several options for major changes in the format of axis IV to be recommended to the DSM-IV Task Force.
《精神疾病诊断与统计手册》第三版的第四轴“心理社会应激源的严重程度”令许多人失望，因为在临床和研究环境中该轴的使用频率明显不高。本报告是对有关第四轴的使用、信度和效度的文献综述。尽管多轴评估的概念颇具吸引力，但临床医生并未常规使用第四轴，这可能是因为他们没有完全理解评分过程中涉及的复杂性。相对较少的关于第四轴的已发表实证研究表明，除了在规划临床干预时识别严重心理社会应激源方面有价值外，其信度一般，效度有限。本综述结果促使《精神疾病诊断与统计手册》第四版多轴问题工作组考虑对第四轴的格式进行重大更改的几种选择，以便推荐给《精神疾病诊断与统计手册》第四版工作组。
