The proposed study represents the follow-up evaluation phase of the """"""""Clinical Validity of the DSM-III Diagnostic System"""""""" study in progress at Western Psychiatric Institute and Clinic. The objective of the proposed research is to investigate empirically the predictive validity of major components of the DSM-III multiaxial diagnostic system. This type of validity represents an evaluative criterion encompassing the strongest combination of scientific value and clinical usefulness. Predictive validity studies will focus on the ability of the initial diagnostic judgments to predict treatment utilization patterns (both inpatient and outpatient), as well as outcome variables such as symptomatological status and adaptive functioning. Additionally, some aspects of the course and stability of illness will be considered. The proposed study will involve the follow-up evaluation of the approximately 500 participants in the baseline study in progress at WPIC. Thirty-three months after the baseline evaluation, participants will be scheduled for a follow-up assessment. This will consist of a diagnostic interview covering the five axes of DSM-III (I. Psychiatric Syndromes, II. Personality Disorders, III. Physical Disorders, IV. Psychosocial Stressors, V. Highest Level of Adaptive Functioning in the Past Year) and an additional sixth axis routinely used at WPIC (VI. Current Functioning at Work/School, with Family and with other Individuals and Groups). In addition, instruments to appraise various aspects of treatment utilization, patient outcome, and course of illness will be employed. The evaluating team conducting each follow-up assessment will consist of a master's level clinician experienced in psychiatric assessment working in collaboration with a faculty clinical psychiatrist. The approximate length of the interview will be 2-1/2 hours. The research questions posed in the proposal will be answered through frequency analyses and discrete multivariate analyses addressing the value of major diagnostic categories in Axis I for the prediction of treatment utilization patterns and outcome at the thirty-three month follow-up assessment. Furthermore, enhancement of the predictive validity of Axis I by the other Axes in DSM-III will also be examined.
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