Interrater reliability of the assessment of DSM-IV Axis IV psychosocial stressors and environmental problems.

The interrater reliability of the DSM-IV axis IV psychosocial stressors was investigated in a retrospective chart review study. The complete charts of 98 patients admitted to a specialized psychiatric ward were independently evaluated by three trained clinicians and rated on a questionnaire form comprising the presence and severity of the nine psychosocial stressors of DSM-IV axis IV (DSMSTR9; absent scored 0; mild, 1-3; moderate, 4-6; severe, 6-10). Chance-corrected intraclass correlations (ICC) were calculated for the interrater reliability of DSMSTR9 stressors. DSMSTR9 stressors exhibited sufficiently high levels of interrater reliability regarding presence (ICC = 0.560-0.943; p < 0.0005) and severity (ICC = 0.584-0.953; p < 0.0005) of stressors with slightly higher ICCs for severity assessments. Problems related to the social environment showed the lowest ICCs. According to the present results, the presence and severity of DSM-IV axis IV stressors can be scored sufficiently reliably even in retrospective studies. Including the assessment of presence and severity of DSM-IV axis IV psychosocial and environmental problems in future DSM versions, using a 4-point scale can therefore be recommended.