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

Terluin, Berend; van Marwijk, Harm W. J.; Adèr, Herman J.; de Vet, Henrica C. W.; Penninx, Brenda W. J. H.; Hermens, Marleen L. M.; van Boeijen, Christine A.; van Balkom, Anton J. L. M.; van der Klink, Jac J. L.; Stalman, Wim A. B.
January 2006
BMC Psychiatry;2006, Vol. 6, p34
Academic Journal
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 intercorrelations (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.


Related Articles

  • Human genetics: Short tales of depression. Greaves, Sarah // Nature Reviews Genetics;Sep2003, Vol. 4 Issue 9, p674 

    Discusses research being done on specific genes that are involved in modulating link between stress and depression. Reference to a study by A. Caspi et al, published in the 20003 issue of the journal "Science"; Response of people at risk from depression to stressful events; Association between...

  • Comparison of Pharmacological Treatment Response between Situational and Non-situational Depressions. Garvey, Michael J.; Schaffer, Charles B.; Tuason, V.B. // British Journal of Psychiatry;Oct84, Vol. 145, p363 

    Fifty-one patients with a primary major depressive disorder preceded by a stressful environmental event were compared for their response to pharmacological treatment with 75 depressives who experienced no stressful life event before illness episodes. There was no difference between the groups in...

  • Cognitive Vulnerability–Stress Model of Depression During Adolescence: Investigating Depressive Symptom Specificity in a Multi-Wave Prospective Study. Hankin, Benjamin // Journal of Abnormal Child Psychology;Oct2008, Vol. 36 Issue 7, p999 

    Depression commonly co-occurs with anxiety and externalizing problems. Etiological factors from a central cognitive theory of depression, the Hopelessness Theory (Abramson et al. Psychological Review, 96, 358–372, 1989), were examined to evaluate whether a negative inferential style about...

  • The Prevalence of Depression in Older U.S. Women: 2006 Behavioral Risk Factor Surveillance System. McGuire, Lisa C.; Strine, Tara W.; Vachirasudlekha, Stephanie; Mokdad, Ali H.; Anderson, Lynda A. // Journal of Women's Health (15409996);May2008, Vol. 17 Issue 4, p501 

    Depression, a type of mood disorder, is associated with psychological distress and suffering, and it can lead to impairments in physical, mental, and social functioning. The goal of this commentary is to provide an estimate of the prevalence of current depression and lifetime diagnosis for...

  • Alcohol consumption as a risk factor for anxiety and depression: Results from the longitudinal follow-up of the National Psychiatric Morbidity Survey. Haynes, Jonathan C.; Farrell, Michael; Singleton, Nicola; Meltzer, Howard; Araya, Ricardo; Lewis, Glyn; Wiles, Nicola J. // British Journal of Psychiatry;Dec2005, Vol. 187, p544 

    Background Longitudinal studies have been inconclusive in identifying alcohol as a risk factor for anxiety and depression. Aims To examine whether excessive alcohol consumption is a risk factor for anxiety and depression in the general population, and whether anxiety and depression are risk...

  • THE PREVALENCE AND CORRELATES OF DEPRESSION AMONG COLLEGE STUDENTS. Lindsey, Billie J.; Fabiano, Patricia; Stark, Chris // College Student Journal;Dec2009 Part A, Vol. 43 Issue 4, p999 

    This study examined depression among a random sample of students (N=618) enrolled in a medium size university in the Pacific Northwest who responded to the American College Health Association's National College Health Assessment. The results indicated that one in four students experienced...

  • RELATIONSHIP OF SELF-REPORTED MYSTICISM WITH DEPRESSION AND ANXIETY IN IRANIAN MUSLIMS. Ghorbani, Nima; Watson, P. J.; Rostami, Reza // Psychological Reports;Apr2007, Vol. 100 Issue 2, p451 

    This study examined relationships of self-reported Mysticism with dispositional Depression and Anxiety in Iranian Muslims. The sample contained 80 women and 51 men undergraduates who volunteered to participate (M age=20.5 yr., SD=2.0). Participants responded to the Hood Mysticism Scale and to...

  • HEADING FOR A breakdown. Campbell, Annette; Cassimatis, Georgia // Woman's Day (Australia Edition);2/28/2005, Vol. 57 Issue 9, p74 

    Presents information on nervous breakdown which is a combination of depression and a generalized anxiety disorder. Stresses in life that may contribute to a nervous breakdown; Impediment to recovery from a nervous breakdown; Persons who are at risk of developing a nervous breakdown.

  • Adult Affective Disorder and Early Environment. Rodgers, Bryan // British Journal of Psychiatry;Oct90, Vol. 157, p539 

    Childhood precursors of symptoms of depression and anxiety were investigated in a national population sample of over 3000 men and women, aged 36 years. Early-life data had been collected prospectively for all subjects. A number of factors, differing for men and women, were found to be...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics