THE DSM-IV FIELD TRIAL FOR MIXED ANXIETY-DEPRESSION

Objective: This field trial was designed to answer four questions. Fir st, are patients presenting with anxious or depressed symptoms that ar e associated with significant impairment but do not meet DSM-III-R def initional thresholds for axis I anxiety or mood disorders Second, is t he impairment experienced by these patients simply the consequence of the severity of their medical conditions Third, what percent of these patients present with depressive symptoms only, anxious symptoms only, and a mixture of both? Fourth, how should the operational criteria fo r the syndrome(s) presented by these patients be defined? Method: A to tal of 666 patients from five primary cave medical site:; and two outp atient mental health sites were administered a semistructured psychiat ric intel view. Results: Patients presenting with affective symptoms t hat did not meet definitional thresholds for DSM-III-R axis I disorder s were at least as common as patients with several of the already esta blished anxiety and mood disorders in each of the seven sites, and the ir disorders were associated with significant distress or impairment. A nonspecific pattern of anxious and depressed symptoms was the modal presentation among these patients with currently subdefinitional thres hold disorders, and they could be significantly differentiated in term s of current symptoms from patients presenting with a principal diagno sis of generalized anxiety disorder, major depressive episode, or pani c disorder with agoraphobia. Conclusions: The authors recommend that a mixed anxiety-depression category be included in the DSM-IV appendix for proposed diagnostic categories that need further study. A criteria set is proposed.