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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.

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Related in: MedlinePlus

Receiver operating characteristic (ROC) curves of the 4DSQ scales with respect to detecting a DSM-IV major depression. Dis = Distress score, Dep = Depression score, Anx = Anxiety score, Som = Somatization score, AUC = Area Under the Curve, CI = 95% confidence interval.
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Figure 2: Receiver operating characteristic (ROC) curves of the 4DSQ scales with respect to detecting a DSM-IV major depression. Dis = Distress score, Dep = Depression score, Anx = Anxiety score, Som = Somatization score, AUC = Area Under the Curve, CI = 95% confidence interval.

Mentions: In study D we had 102 instances with both a complete diagnostic assessment and complete results of the 4DSQ. The diagnosis major depression was established in 56%. The mean 4DSQ scores are shown in Table 6. The diagnosis major depression was associated with all four 4DSQ scales. The ROC curves for the 4DSQ scales detecting DSM-IV major depression are shown in Figure 2. The Depression score was the best discriminator between patients with and without a major depression, the AUC of the Depression score (0.83) being significantly larger than the AUCs of the Anxiety and Somatization scores (p-values 0.002 and 0.022 respectively). However, the Distress score performed almost as good, as the difference between the AUCs was not statistically significant (p = 0.555). The Depression score, using a cut-off of ≥ 6, had a sensitivity of 0.72 and a specificity of 0.80 for detecting major depression. Logistic regression analysis showed that the Depression score contributed the most to the prediction of major depression, but curiously, the Somatization score contributed a little to the prediction of major depression in addition (Table 7). For every increase of the Depression score by 1 point (the scale range is 12 points) the odds for having a major depression increased by 46%. Note that the Distress score did not have any additional value with respect to the prediction of major depression with the Depression score already in the equation.


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 DSM-IV major depression. 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 2: Receiver operating characteristic (ROC) curves of the 4DSQ scales with respect to detecting a DSM-IV major depression. Dis = Distress score, Dep = Depression score, Anx = Anxiety score, Som = Somatization score, AUC = Area Under the Curve, CI = 95% confidence interval.
Mentions: In study D we had 102 instances with both a complete diagnostic assessment and complete results of the 4DSQ. The diagnosis major depression was established in 56%. The mean 4DSQ scores are shown in Table 6. The diagnosis major depression was associated with all four 4DSQ scales. The ROC curves for the 4DSQ scales detecting DSM-IV major depression are shown in Figure 2. The Depression score was the best discriminator between patients with and without a major depression, the AUC of the Depression score (0.83) being significantly larger than the AUCs of the Anxiety and Somatization scores (p-values 0.002 and 0.022 respectively). However, the Distress score performed almost as good, as the difference between the AUCs was not statistically significant (p = 0.555). The Depression score, using a cut-off of ≥ 6, had a sensitivity of 0.72 and a specificity of 0.80 for detecting major depression. Logistic regression analysis showed that the Depression score contributed the most to the prediction of major depression, but curiously, the Somatization score contributed a little to the prediction of major depression in addition (Table 7). For every increase of the Depression score by 1 point (the scale range is 12 points) the odds for having a major depression increased by 46%. Note that the Distress score did not have any additional value with respect to the prediction of major depression with the Depression score already in the equation.

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