Identifying the Factor Structure of the DSM-5 Level 1 Cross-Cutting Symptom Measure

Gibbons, A.; Farmer, C.; Shaw, J. S.; Chung, J. Y.

The DSM-5 Level 1 Cross-Cutting Symptom Measure (DSM-XC) is a transdiagnostic mental health symptom measure that has shown promise in informing clinical diagnostic evaluations and as a screening tool for research. However, few studies have assessed the latent dimensionality of the DSM-XC or provided guidance on how to score the survey. In this report, we examined the factor structure of the DSM-XC in a sample of over 3500 participants enrolled in a protocol on the mental health impact of COVID-19 conducted through the National Institute of Mental Health Intramural Research Program (NIMH IRP) (ClinicalTrials.gov identifier: NCT04339790). We began by conducting an exploratory factor analysis (EFA) to identify the best solution for our data, and then employed a confirmatory factor analyses (CFAs) to evaluate the fit of the two-factor solution proposed by Lace and Merz (Lace & Merz, 2020), the fit of our proposed solution, and the measurement invariance of our proposed solution across age, sex, and calendar time. We found a six-factor solution stemming from our EFAs to best fit our data. Each factor captures symptoms related to a specific construct of psychopathology: mood, worry, activation, somatic, confusion, and substance use. Future research should evaluate this six-factor structure using additional datasets to confirm its consistency across research populations and settings.