Axis IV: a reliable and valid measure of psychosocial stressors?

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.