Is the DSM-5 anxious distress specifier sufficient for measuring anxiety in depressed patients? Implications for measurement-based care

BACKGROUND: We examined whether a self-report measure of the DSM-5 anxious distress specifier, the Clinically Useful Depression Outcome Scale Anxious Distress Specifier Subscale (CUDOS-A), was as valid as a broader measure of the severity of anxiety, the Clinically Useful Anxiety Outcome Scale (CUXOS), in patients with depression.

METHODS: Two hundred ninety-four patients with major depressive disorder were administered a semi-structured interview. The patients completed self-report measures of depression, anxiety, and irritability. Sensitivity to change was examined in a subset of patients.

RESULTS: Both the CUDOS-A and CUXOS were more highly correlated with measures of anxiety than with measures of the other symptom domains. Patients with anxiety disorders scored significantly higher on both mea­sures than did patients with no current anxiety disorder. Both measures were equally correlated with measures of coping, general well-being, and functioning. A large effect size of treatment was found for both measures (CUDOS-A: d = 1.2; CUXOS: d = 1.3).

CONCLUSIONS: Both the CUDOS-A and CUXOS were valid self-report mea­sures of anxiety symptom severity in patients with depression. Because anxiety is common in patients with depression, the addition of a small number of items assessing the DSM-5 anxious distress criteria should be added to depression measures and used in measurement-based care efforts.

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