A brief, clinically useful, clinician-rated dimensional rating system for psychiatric diagnoses: reliability and validity in psychiatric outpatients.

BACKGROUND: In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we describe the development of a dimensional rating system for Axis I disorders. METHODS: We evaluated 1,600 psychiatric outpatients with a semi-structured diagnostic interview for Axis I disorders and completed a self-report measure of psychosocial morbidity. A Standardized Clinical Outcome Rating (SCOR), a 7-point dimensional rating, was made for 17 Axis I disorders and 1 symptom construct. RESULTS: The dimensional ratings were highly reliable. After controlling for the number of Axis I disorders, each of the partial correlations between the dimensional rating and the measures of psychosocial morbidity was significant (mean partial r = 0.21). However, when the dimensional score was controlled, none of the partial correlations between the sum of the number of Axis I disorders and measures of psychosocial morbidity were significant (mean partial r = 0.03). CONCLUSIONS: The SCORs are brief standardized outcome ratings that clinicians can incorporate into routine clinical practice without incurring undue burden. These ratings could make it more feasible to conduct effectiveness studies in clinical practice and to extend measurement-based care recommendations to include clinical ratings as well as self-report assessments.