Department of Psychology, University of North Texas, Denton, TX, USA.
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, RI, USA.
Psychol Med. 2023 Oct;53(13):6142-6149. doi: 10.1017/S0033291722003324. Epub 2022 Nov 29.
Quantitatively derived dimensional models of psychopathology enjoy overwhelming empirical support, and a large and active community of psychopathology researchers has been establishing an empirically based dimensional hierarchical taxonomy of psychopathology (or HiTOP) as a strong candidate replacement for the current categorical classification system. The hierarchical nature of this taxonomy implies that different levels of resolution are likely to be optimal for different purposes. Our aim was to identify which level of detail is likely to provide optimal validity and explanatory power with regard to relevant clinical variables.
In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we used data from a sample of 2900 psychiatric outpatients to compare different levels from a bass-ackwards model of psychopathology in relation to psychosocial impairment across different domains (global functioning, inability to work, social functioning, suicidal ideation, history of suicide attempts, history of psychiatric hospitalization).
All functioning indices were significantly associated with general psychopathology, but more complex levels provided significant incremental validity. The optimal level of complexity varied across functioning indices, suggesting that there is no single 'best' level for understanding relations between psychopathology and functioning.
Results support the hierarchical organization of psychopathology dimensions with regard to validity considerations and downstream implications for applied assessment. It would be fruitful to develop and implement measurement of these dimensions at the appropriate level for the purpose at hand. These findings can be used to guide HiTOP-consistent assessment in other research and clinical settings.
定量得出的精神病理学维度模型得到了压倒性的经验支持，大量活跃的精神病理学研究人员一直在建立一个基于经验的精神病理学维度分层分类法（或 HiTOP），作为当前分类系统的强有力替代方案。该分类法的分层性质意味着不同的分辨率水平可能更适合不同的目的。我们的目的是确定哪种详细程度在与相关临床变量相关的有效性和解释力方面可能是最佳的。
在罗德岛改善诊断评估和服务项目的本报告中，我们使用了 2900 名精神病门诊患者样本中的数据，比较了从精神病理学的反向模型的不同层次与不同领域的心理社会障碍（整体功能、无法工作、社交功能、自杀意念、自杀企图史、精神病住院史）。
所有功能指标都与一般精神病理学显著相关，但更复杂的层次提供了显著的增量有效性。复杂程度的最佳水平因功能指标而异，这表明理解精神病理学和功能之间关系没有单一的“最佳”水平。
结果支持精神病理学维度的分层组织，考虑到有效性考虑因素以及对应用评估的下游影响。开发和实施针对手头目的的这些维度的测量将是富有成效的。这些发现可用于指导其他研究和临床环境中的 HiTOP 一致评估。
