Limits...
The Four-Dimensional Symptom Questionnaire (4DSQ): a validation study of a multidimensional self-report questionnaire to assess distress, depression, anxiety and somatization.

Terluin B, van Marwijk HW, Adèr HJ, de Vet HC, Penninx BW, Hermens ML, van Boeijen CA, van Balkom AJ, van der Klink JJ, Stalman WA - BMC Psychiatry (2006)

Bottom Line: CFA confirmed the 4-factor structure with a comparative fit index (CFI) of 0.92.Measures of stress (i.e. life events, psychosocial problems, and work stress) were mainly associated with Distress, while Distress, in turn, was mainly associated with psychosocial dysfunctioning, including sick leave.The 4DSQ Distress scale appears to measure the most general, most common, expression of psychological problems.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Practice, EMGO-Institute, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. b.terluin@vumc.nl

ABSTRACT

Background: The Four-Dimensional Symptom Questionnaire (4DSQ) is a self-report questionnaire that has been developed in primary care to distinguish non-specific general distress from depression, anxiety and somatization. The purpose of this paper is to evaluate its criterion and construct validity.

Methods: Data from 10 different primary care studies have been used. Criterion validity was assessed by comparing the 4DSQ scores with clinical diagnoses, the GPs' diagnosis of any psychosocial problem for Distress, standardised psychiatric diagnoses for Depression and Anxiety, and GPs' suspicion of somatization for Somatization. ROC analyses and logistic regression analyses were used to examine the associations. Construct validity was evaluated by investigating the inter-correlations between the scales, the factorial structure, the associations with other symptom questionnaires, and the associations with stress, personality and social functioning. The factorial structure of the 4DSQ was assessed through confirmatory factor analysis (CFA). The associations with other questionnaires were assessed with Pearson correlations and regression analyses.

Results: Regarding criterion validity, the Distress scale was associated with any psychosocial diagnosis (area under the ROC curve [AUC] 0.79), the Depression scale was associated with major depression (AUC = 0.83), the Anxiety scale was associated with anxiety disorder (AUC = 0.66), and the Somatization scale was associated with the GPs' suspicion of somatization (AUC = 0.65). Regarding the construct validity, the 4DSQ scales appeared to have considerable inter-correlations (r = 0.35-0.71). However, 30-40% of the variance of each scale was unique for that scale. CFA confirmed the 4-factor structure with a comparative fit index (CFI) of 0.92. The 4DSQ scales correlated with most other questionnaires measuring corresponding constructs. However, the 4DSQ Distress scale appeared to correlate with some other depression scales more than the 4DSQ Depression scale. Measures of stress (i.e. life events, psychosocial problems, and work stress) were mainly associated with Distress, while Distress, in turn, was mainly associated with psychosocial dysfunctioning, including sick leave.

Conclusion: The 4DSQ seems to be a valid self-report questionnaire to measure distress, depression, anxiety and somatization in primary care patients. The 4DSQ Distress scale appears to measure the most general, most common, expression of psychological problems.

Show MeSH

Related in: MedlinePlus

Receiver operating characteristic (ROC) curves of the 4DSQ scales with respect to detecting a psychosocial diagnosis in general practice patients. Dis = Distress score, Dep = Depression score, Anx = Anxiety score, Som = Somatization score, AUC = Area Under the Curve, CI = 95% confidence interval.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC1590008&req=5

Figure 1: Receiver operating characteristic (ROC) curves of the 4DSQ scales with respect to detecting a psychosocial diagnosis in general practice patients. Dis = Distress score, Dep = Depression score, Anx = Anxiety score, Som = Somatization score, AUC = Area Under the Curve, CI = 95% confidence interval.

Mentions: In study A the GP diagnosis was missing in 90 cases (4%). In 417 of the remaining 2,037 patients (20%) the GP recorded a psychosocial diagnosis/reason for encounter. The psychosocial and somatic groups differed significantly in all four dimensions of the 4DSQ (Table 4). The ROC analysis revealed that all four 4DSQ scales were associated with any psychosocial diagnosis/reason for encounter to some extent (Figure 1), but the Distress score yielded the highest AUC (0.79), being significantly higher than the AUCs of the Depression, Anxiety and Somatization scores (all p-values < 0.001). A Distress cut-off score of ≥ 11 had a sensitivity of 0.71 and a specificity of 0.72 for "detecting" any psychosocial diagnosis/reason for encounter. The final logistic regression model revealed that whether the GP made a psychosocial or a somatic diagnosis was mainly "predicted" by the Distress score (Table 5). With every increase of the Distress score by 1 point (the scale range is 32 points), the odds to receive a psychosocial diagnosis/reason for encounter increased by 13%.


The Four-Dimensional Symptom Questionnaire (4DSQ): a validation study of a multidimensional self-report questionnaire to assess distress, depression, anxiety and somatization.

Terluin B, van Marwijk HW, Adèr HJ, de Vet HC, Penninx BW, Hermens ML, van Boeijen CA, van Balkom AJ, van der Klink JJ, Stalman WA - BMC Psychiatry (2006)

Receiver operating characteristic (ROC) curves of the 4DSQ scales with respect to detecting a psychosocial diagnosis in general practice patients. Dis = Distress score, Dep = Depression score, Anx = Anxiety score, Som = Somatization score, AUC = Area Under the Curve, CI = 95% confidence interval.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1590008&req=5

Figure 1: Receiver operating characteristic (ROC) curves of the 4DSQ scales with respect to detecting a psychosocial diagnosis in general practice patients. Dis = Distress score, Dep = Depression score, Anx = Anxiety score, Som = Somatization score, AUC = Area Under the Curve, CI = 95% confidence interval.
Mentions: In study A the GP diagnosis was missing in 90 cases (4%). In 417 of the remaining 2,037 patients (20%) the GP recorded a psychosocial diagnosis/reason for encounter. The psychosocial and somatic groups differed significantly in all four dimensions of the 4DSQ (Table 4). The ROC analysis revealed that all four 4DSQ scales were associated with any psychosocial diagnosis/reason for encounter to some extent (Figure 1), but the Distress score yielded the highest AUC (0.79), being significantly higher than the AUCs of the Depression, Anxiety and Somatization scores (all p-values < 0.001). A Distress cut-off score of ≥ 11 had a sensitivity of 0.71 and a specificity of 0.72 for "detecting" any psychosocial diagnosis/reason for encounter. The final logistic regression model revealed that whether the GP made a psychosocial or a somatic diagnosis was mainly "predicted" by the Distress score (Table 5). With every increase of the Distress score by 1 point (the scale range is 32 points), the odds to receive a psychosocial diagnosis/reason for encounter increased by 13%.

Bottom Line: CFA confirmed the 4-factor structure with a comparative fit index (CFI) of 0.92.Measures of stress (i.e. life events, psychosocial problems, and work stress) were mainly associated with Distress, while Distress, in turn, was mainly associated with psychosocial dysfunctioning, including sick leave.The 4DSQ Distress scale appears to measure the most general, most common, expression of psychological problems.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Practice, EMGO-Institute, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. b.terluin@vumc.nl

ABSTRACT

Background: The Four-Dimensional Symptom Questionnaire (4DSQ) is a self-report questionnaire that has been developed in primary care to distinguish non-specific general distress from depression, anxiety and somatization. The purpose of this paper is to evaluate its criterion and construct validity.

Methods: Data from 10 different primary care studies have been used. Criterion validity was assessed by comparing the 4DSQ scores with clinical diagnoses, the GPs' diagnosis of any psychosocial problem for Distress, standardised psychiatric diagnoses for Depression and Anxiety, and GPs' suspicion of somatization for Somatization. ROC analyses and logistic regression analyses were used to examine the associations. Construct validity was evaluated by investigating the inter-correlations between the scales, the factorial structure, the associations with other symptom questionnaires, and the associations with stress, personality and social functioning. The factorial structure of the 4DSQ was assessed through confirmatory factor analysis (CFA). The associations with other questionnaires were assessed with Pearson correlations and regression analyses.

Results: Regarding criterion validity, the Distress scale was associated with any psychosocial diagnosis (area under the ROC curve [AUC] 0.79), the Depression scale was associated with major depression (AUC = 0.83), the Anxiety scale was associated with anxiety disorder (AUC = 0.66), and the Somatization scale was associated with the GPs' suspicion of somatization (AUC = 0.65). Regarding the construct validity, the 4DSQ scales appeared to have considerable inter-correlations (r = 0.35-0.71). However, 30-40% of the variance of each scale was unique for that scale. CFA confirmed the 4-factor structure with a comparative fit index (CFI) of 0.92. The 4DSQ scales correlated with most other questionnaires measuring corresponding constructs. However, the 4DSQ Distress scale appeared to correlate with some other depression scales more than the 4DSQ Depression scale. Measures of stress (i.e. life events, psychosocial problems, and work stress) were mainly associated with Distress, while Distress, in turn, was mainly associated with psychosocial dysfunctioning, including sick leave.

Conclusion: The 4DSQ seems to be a valid self-report questionnaire to measure distress, depression, anxiety and somatization in primary care patients. The 4DSQ Distress scale appears to measure the most general, most common, expression of psychological problems.

Show MeSH
Related in: MedlinePlus