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Original Research

A Clinically Useful Anxiety Outcome Scale

Mark Zimmerman, MD; Iwona Chelminski, PhD;       Diane Young, PhD; and Kristy Dalrymple, PhD

Published: March 9, 2010

Article Abstract

Objective: Standardized scales are increasingly being recommended to measure outcome when treating psychiatric disorders in routine clinical practice. If the standard of care is to change and scales are to be incorporated into clinical practice, then it will be necessary to develop measures that are feasible to use as well as have good psychometric properties. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we describe the reliability and validity of the Clinically Useful Anxiety Outcome Scale (CUXOS). The CUXOS was designed to be a brief (completed in less than 2 minutes), quickly scored (in less than 15 seconds), clinically useful measure that is reliable, valid, and sensitive to change.

Method: Nearly 1,000 psychiatric outpatients completed the CUXOS and were rated on clinician severity indices of depression, anxiety, and anger. A subset of patients completed other self-report symptom severity scales in order to examine discriminant and convergent validity, and a subset completed the CUXOS twice in order to examine test-retest reliability. Sensitivity to change was examined in patients with panic disorder and generalized anxiety disorder.

Results: On average, the CUXOS took less than 1.5 minutes to complete. The scale had high internal consistency and test-retest reliability, and was more highly correlated with other self-report measures of anxiety than with measures of depression, substance use problems, eating disorders, and anger. The CUXOS was more highly correlated with clinician severity ratings of anxiety than with depression and anger, and CUXOS scores were significantly higher in psychiatric outpatients with anxiety disorders than in patients with other psychiatric disorders. Finally, the CUXOS was a valid measure of symptom change.

Conclusions: The results of this large validation study of the CUXOS show that it is a reliable and valid measure of anxiety that is feasible to incorporate into routine clinical practice.

J Clin Psychiatry

Submitted: April 6, 2009; accepted November 10, 2009.

Online ahead of print: March 9, 2010 (doi:10.4088/JCP.09m05264blu).

Corresponding author: Mark Zimmerman, MD, Bayside Medical Center, 235 Plain St, Providence, RI 02905 (

Volume: 71

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