The DOI matches its Crossref record; 202 of the 202 references it cites were found in a registry or an index.
The severity of psychiatric disorders
Open accessAbstract
The issue of the severity of psychiatric disorders has great clinical importance. For example, severity influences decisions about level of care, and affects decisions to seek government assistance due to psychiatric disability. Controversy exists as to the efficacy of antidepressants across the spectrum of depression severity, and whether patients with severe depression should be preferentially treated with medication rather than psychotherapy. Measures of severity are used to evaluate outcome in treatment studies and may be used as meaningful endpoints in clinical practice. But, what does it mean to say that someone has a severe illness? Does severity refer to the number of symptoms a patient is experiencing? To the intensity of the symptoms? To symptom frequency or persistence? To the impact of symptoms on functioning or on quality of life? To the likelihood of the illness resulting in permanent disability or death? Putting aside the issue of how severity should be operationalized, another consideration is whether severity should be conceptualized similarly for all illnesses or be disorder specific. In this paper, we examine how severity is characterized in research and contemporary psychiatric diagnostic systems, with a special focus on depression and personality disorders. Our review shows that the DSM‐5 has defined the severity of various disorders in different ways, and that researchers have adopted a myriad of ways of defining severity for both depression and personality disorders, although the severity of the former was predominantly defined according to scores on symptom rating scales, whereas the severity of the latter was often linked with impairments in functioning. Because the functional impact of symptom‐defined disorders depends on factors extrinsic to those disorders, such as self‐efficacy, resilience, coping ability, social support, cultural and social expectations, as well as the responsibilities related to one's primary role function and the availability of others to assume those responsibilities, we argue that the severity of such disorders should be defined independently from functional impairment.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“This also raises questions about how severity is conceptualized and measured, typically through DSM-5-based scales that overlook broader functional and socio-structural dimensions [179].”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [179]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“However, current formal assessment strategies fail to capture most of this information 49 .”
From The pursuit of euthymia (2020) · cites this paper as [49]
Experimental — accuracy not yet measuredIn the citing paper
“This has been especially highlighted in the case of patients with severe mental disorders who report a greater desire of being involved in clinical decision-making and a need to have a say in the process of care, as compared to individuals receiving assistance for other medical conditions [8–11].”
From The role of shared decision-making in improving adherence to pharmacological treatments in patients with schizophrenia: A clinical review (2020) · cites this paper as [11]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910
Hamilton, M. (1960) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.23.1.56 · Cited by 32,817
Depression and quality of life in older persons: A review
Sivertsen, H., Bjørkløf, G. H., Engedal, K., Selbæk, G., & Helvik, A.-S. (2015) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000437299 · Cited by 14,152
A new depression scale designed to be sensitive to change
Montgomery, S. A., & Åsberg, M. (1979) · British Journal of Psychiatry · doi:10.1192/bjp.134.4.382 · Cited by 13,962
The assessment of anxiety states by rating
HAMILTON, M. (1959) · British Journal of Medical Psychology · doi:10.1111/j.2044-8341.1959.tb00467.x · Cited by 11,455
(1976) · Medical Entomology and Zoology · Cited by 8,899
Le Gall, J.-R. (1993) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.270.24.2957 · Cited by 7,773
Goetz, C. G., Tilley, B. C., Shaftman, S. R., Stebbins, G. T., Fahn, S., Martinez‐Martin, P., Poewe, W., Sampaio, C., Stern, M. B., Dodel, R., et al. (2008) · Movement Disorders · doi:10.1002/mds.22340 · Cited by 7,536
Research works printed but not linked: 6
- National Collaborating Centre for Mental Health, 2009, Depression: the treatment and management of depression in adults
- 10.1001/jama.1993.03510240069035 · DOI · Paper page
- World Health Organization, 2016, International classification of diseases and related health problems, 10th revision
- National Collaborating Centre for Mental Health, 2009, Borderline personality disorder: recognition and management
- Livesley WJ, 2003, Practical management of personality disorders
- Livesley WJ, 2006, General Assessment of Personality Disorder (GAPD)
Cited by
Sorted by citations
Time for united action on depression: a Lancet–World Psychiatric Association Commission
Herrman, H., Patel, V., Kieling, C., Berk, M., Buchweitz, C., Cuijpers, P., Furukawa, T. A., Kessler, R. C., Kohrt, B. A., Maj, M., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02141-3 · Cited by 1,104
Maj, M., Stein, D. J., Parker, G., Zimmerman, M., Fava, G. A., De Hert, M., Demyttenaere, K., McIntyre, R. S., Widiger, T., & Wittchen, H. (2020) · World Psychiatry · doi:10.1002/wps.20771 · Cited by 435
Self-citationTransdiagnostic psychiatry: a systematic review
Fusar‐Poli, P., Solmi, M., Brondino, N., Davies, C., Chae, C., Politi, P., Borgwardt, S., Lawrie, S. M., Parnas, J., & McGuire, P. (2019) · World Psychiatry · doi:10.1002/wps.20631 · Cited by 409
The general factor of psychopathology
Smith, G. T., Atkinson, E. A., Davis, H. A., Riley, E. N., & Oltmanns, J. R. (2020) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-071119-115848 · Cited by 195
Fava, G. A., & Guidi, J. (2020) · World Psychiatry · doi:10.1002/wps.20698 · Cited by 148
Metadata
- Authors
- Zimmerman, M., Morgan, T. A., & Stanton, K.
- Affiliations
- Brown University (US)
- Venue
- World Psychiatry
- Publisher
- Wiley
- Published
- 2018-09-07
- Volume
- 17
- Issue
- 3
- Pages
- 258-275
- ISSN
- 1723-8617 (ISSN-L)
- 2051-5545
- PMC
- PMC6127765
- OpenAlex
- W2890739253
- Cited by
- 227
- References
- 200
- Citations by year
- 2026: 23 · 2025: 32 · 2024: 28 · 2023: 28 · 2022: 49 · 2021: 25 · 2020: 32 · 2019: 9 · 2018: 1
- FWCI
- 19.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- World Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- depression severity, personality disorders, DSM-5, functional disability, symptom rating scales, psychiatric disability, antidepressant efficacy, treatment outcome measures, quality of life
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
