title: A clinically useful self-report measure of the DSM-5 anxious distress specifier for major depressive disorder.
abstract: OBJECTIVE
  To acknowledge the clinical significance of anxiety in depressed patients, DSM-5 included criteria for an anxious distress specifier for major depressive disorder. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we modified our previously published depression scale to include a subscale assessing the DSM-5 anxious distress specifier.
  
  
  METHODS
  From December 1995 to August 2013, 773 psychiatric outpatients with major depressive disorder completed the Clinically Useful Depression Outcome Scale (CUDOS) supplemented with questions for the DSM-5 anxious distress specifier (CUDOS-A). To examine discriminant and convergent validity, the patients were rated on clinician severity indices of depression, anxiety, and irritability. Discriminant and convergent validity was further examined in a subset of patients who completed other self-report symptom severity scales. Test-retest reliability was examined in a subset who completed the CUDOS-A twice. We compared patients who did and did not meet the DSM-5 anxious distress specifier on indices of psychosocial functioning and quality of life.
  
  
  RESULTS
  The CUDOS-A subscale had high internal consistency and test-retest reliability; was more highly correlated with other self-report measures of anxiety than with measures of depression, substance use problems, eating disorders, and anger; and was more highly correlated with clinician severity ratings of anxiety than depression and irritability. CUDOS-A scores were significantly higher in depressed outpatients with a current anxiety disorder than in depressed patients without a comorbid anxiety disorder (P < .001). Finally, patients who met the DSM-5 anxious distress specifier reported poorer psychosocial functioning and quality of life than patients who did not meet the anxious distress specifier.
  
  
  CONCLUSIONS
  In the present study of a large sample of psychiatric outpatients, the CUDOS-A was a reliable and valid measure of the DSM-5 anxious distress specifier for major depressive disorder.
authors.affiliation: 146 West River St, Providence, RI 02904 mzimmerman@lifespan.org.
authors.forename: Mark
authors.initials: M
authors.lastname: Zimmerman
authors.forename: Iwona
authors.initials: I
authors.lastname: Chelminski
authors.forename: Diane
authors.initials: D
authors.lastname: Young
authors.forename: Kristy
authors.initials: K
authors.lastname: Dalrymple
authors.forename: Emily
authors.initials: E
authors.lastname: Walsh
authors.forename: Lia
authors.initials: L
authors.lastname: Rosenstein
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory / Q000706:statistics & numerical data*; D011567:Psychiatric Department, Hospital; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012237:Rhode Island; D011795:Surveys and Questionnaires