Prescreen: DSM-5-TR Self-Rated Level 1 Cross-Cutting Symptom Measure — Adult

Foundational Context

The Level 1 Cross-Cutting Measure was created as part of the DSM-5 field trials to improve early identification of symptoms that span diagnostic boundaries. Traditional categorical diagnoses can obscure comorbidity or evolving symptom pictures; the Level 1 Measure brings those patterns into view through a brief, structured self-report. Its validation demonstrated strong usability and reliability across outpatient and inpatient settings, making it suitable for general mental health, primary care, and specialty clinics.

How It Works in HiBoop

HiBoop uses the DSM-5-TR Level 1 Measure as the platform’s primary prescreener, providing a broad snapshot of a patient’s emotional, cognitive, and behavioural symptoms. These results work alongside condition-specific screeners embedded within other long-form assessments (e.g., ASRS for ADHD, SIDAS for suicidality, ASSIST for substance use).

If a clinician selects an alternative validated screener for a specific domain—such as AUDIT instead of the ASSIST for alcohol use—HiBoop automatically swaps the corresponding prescreen item to maintain assessment integrity and avoid redundant scoring.

Together, this system helps clinicians identify early indicators of severity, triage efficiently, and guide which focused assessments may be needed.

A more detailed breakdown of routing logic and pre-screener behaviour is available in our How It Works documentation.

Prescreen–Assessment Mapping

What the Assessment Measures

The Level 1 Measure screens symptoms across 15 key mental health domains, including depression, anxiety, sleep problems, trauma-related symptoms, psychosis, dissociation, substance use, and more. Each item captures symptom severity over the past two weeks on a 0–4 scale (“None” → “Severe”).

Instructions to Clinicians

The DSM-5-TR Level 1 Cross-Cutting Symptom Measure is a self- or informant-rated measure that assesses mental health domains that are important across psychiatric diagnoses. It is intended to help clinicians identify additional areas of inquiry that may have significant impact on the individual’s treatment and prognosis. In addition, the measure may be used to track changes in the individual’s symptom presentation over time.

This adult version of the measure consists of 23 questions that assess 13 psychiatric domains, including depression, anger, mania, anxiety, somatic symptoms, suicidal ideation, psychosis, sleep problems, memory, repetitive thoughts and behaviors, dissociation, personality functioning, and substance use. Each item inquires about how much (or how often) the individual has been bothered by the specific symptom during the past 2 weeks.

If the individual is of impaired capacity and unable to complete the form (e.g., an individual with dementia), a knowledgeable adult informant may complete the measure. The measure was found to be clinically useful and to have good test-retest reliability in the DSM-5 Field Trials that were conducted in adult clinical samples across the United States and in Canada.

Interpretation Guidelines

Scoring Structure

Each item on the measure is rated on a 5-point scale (0=none or not at all; 1=slight or rare, less than a day or two; 2=mild or several days; 3=moderate or more than half the days; and 4=severe or nearly every day). The score on each item within a domain should be reviewed.

Because additional inquiry is based on the highest score on any item within a domain, the clinician is asked to indicate that score in the “Highest Domain Score” column. A rating of mild (i.e., 2) or greater on any item within a domain (except for substance use, suicidal ideation, and psychosis) may serve as a guide for additional inquiry and follow up to determine if a more detailed assessment for that domain is necessary.

For substance use, suicidal ideation, and psychosis, a rating of slight (i.e., 1) or greater on any item within the domain may serve as a guide for additional inquiry and follow-up to determine if a more detailed assessment is needed.

• Items scored 0–4
• No total score
• Interpretation is domain-specific

Clinical Meaning

• Score ≥2 (Moderate/Severe) → Follow-up assessment recommended
• Any nonzero suicidal ideation → Immediate clinical attention required
• Mild symptoms (score of 1) may still be clinically relevant when persistent or impairing
  

Frequency of Use

To track change in the individual’s symptom presentation over time, the measure may be completed at regular intervals as clinically indicated, depending on the stability of the individual’s symptoms and treatment status. For individuals with impaired capacity, it is preferable that the same knowledgeable informant completes the measures at follow-up appointments. Consistently high scores on a particular domain may indicate significant and problematic symptoms for the individual that might warrant further assessment, treatment, and follow-up. Clinical judgment should guide decision making.

Psychometric Properties

Reliability

• Strong test–retest reliability in DSM-5 field trials
• High clinician agreement on item interpretation

Validity

• Excellent convergent validity with disorder-specific measures
• Sensitive to clinical change, supporting use in monitoring
• Validated across outpatient, inpatient, and primary care settings

Administration Considerations

• Suitable for intake, triage, and monitoring
• Complements targeted assessment workflows
• Essential for identifying comorbidity early
• Works across mental health and primary care settings
• Requires follow-up assessment for elevated domains

The DSM-5-TR Level 2 Cross-Cutting Symptom Measures may be used to provide more detailed information on the symptoms associated with some of the Level 1 domains (see Table 1 below). With the "Include Related Assessments" Setting turned on HiBoop automatically routes clinicians and clients to a relevant long form assessment for that given domain.

Limitations

• Not diagnostic; only flags areas of concern
• Some domains (SI, psychosis) require immediate clinical assessment
• Limited depth per domain (1–3 items each)
• Relies on patient self-report, which may be influenced by insight, mood, or context