To what extent does the anxiety scale of the Four Dimensional Symptom Questionnaire (4DSQ) detect specific types of anxiety disorder in primary care?

A psychometric study

B. Terluin, D.B. Oosterbaan, E.P.M. Brouwers, A.H.M. van Straten, P. van de Ven, W. Langerak, H.W.J. van Marwijk

Research output: Contribution to journalArticleScientificpeer-review

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Abstract

Background
Anxiety scales may help primary care physicians to detect specific anxiety disorders among the many emotionally distressed patients presenting in primary care. The anxiety scale of the Four-Dimensional Symptom Questionnaire (4DSQ) consists of an admixture of symptoms of specific anxiety disorders. The research questions were: (1) Is the anxiety scale unidimensional or multidimensional? (2) To what extent does the anxiety scale detect specific DSM-IV anxiety disorders? (3) Which cut-off points are suitable to rule out or to rule in (which) anxiety disorders?
Methods
We analyzed 5 primary care datasets with standardized psychiatric diagnoses and 4DSQ scores. Unidimensionality was assessed through confirmatory factor analysis (CFA). We examined mean scores and anxiety score distributions per disorder. Receiver operating characteristic (ROC) analysis was used to determine optimal cut-off points.
Results
Total n was 969. CFA supported unidimensionality. The anxiety scale performed slightly better in detecting patients with panic disorder, agoraphobia, social phobia, obsessive compulsive disorder (OCD) and post traumatic stress disorder (PTSD) than patients with generalized anxiety disorder (GAD) and specific phobia. ROC-analysis suggested that ≥4 was the optimal cut-off point to rule out and ≥10 the cut-off point to rule in anxiety disorders.
Conclusions
The 4DSQ anxiety scale measures a common trait of pathological anxiety that is characteristic of anxiety disorders, in particular panic disorder, agoraphobia, social phobia, OCD and PTSD. The anxiety score detects the latter anxiety disorders to a slightly greater extent than GAD and specific phobia, without being able to distinguish between the different anxiety disorder types. The cut-off points ≥4 and ≥10 can be used to separate distressed patients in three groups with a relatively low, moderate and high probability of having one or more anxiety disorders.
Original languageEnglish
Article number121
JournalBMC Psychiatry
Volume14
Issue number1
DOIs
Publication statusPublished - 2014

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Agoraphobia
Panic Disorder
Statistical Factor Analysis
Surveys and Questionnaires
Primary Care Physicians
Diagnostic and Statistical Manual of Mental Disorders
Social Phobia
Specific Phobia

Cite this

Terluin, B. ; Oosterbaan, D.B. ; Brouwers, E.P.M. ; van Straten, A.H.M. ; van de Ven, P. ; Langerak, W. ; van Marwijk, H.W.J. / To what extent does the anxiety scale of the Four Dimensional Symptom Questionnaire (4DSQ) detect specific types of anxiety disorder in primary care? A psychometric study. In: BMC Psychiatry. 2014 ; Vol. 14, No. 1.
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title = "To what extent does the anxiety scale of the Four Dimensional Symptom Questionnaire (4DSQ) detect specific types of anxiety disorder in primary care?: A psychometric study",
abstract = "BackgroundAnxiety scales may help primary care physicians to detect specific anxiety disorders among the many emotionally distressed patients presenting in primary care. The anxiety scale of the Four-Dimensional Symptom Questionnaire (4DSQ) consists of an admixture of symptoms of specific anxiety disorders. The research questions were: (1) Is the anxiety scale unidimensional or multidimensional? (2) To what extent does the anxiety scale detect specific DSM-IV anxiety disorders? (3) Which cut-off points are suitable to rule out or to rule in (which) anxiety disorders?MethodsWe analyzed 5 primary care datasets with standardized psychiatric diagnoses and 4DSQ scores. Unidimensionality was assessed through confirmatory factor analysis (CFA). We examined mean scores and anxiety score distributions per disorder. Receiver operating characteristic (ROC) analysis was used to determine optimal cut-off points.ResultsTotal n was 969. CFA supported unidimensionality. The anxiety scale performed slightly better in detecting patients with panic disorder, agoraphobia, social phobia, obsessive compulsive disorder (OCD) and post traumatic stress disorder (PTSD) than patients with generalized anxiety disorder (GAD) and specific phobia. ROC-analysis suggested that ≥4 was the optimal cut-off point to rule out and ≥10 the cut-off point to rule in anxiety disorders.ConclusionsThe 4DSQ anxiety scale measures a common trait of pathological anxiety that is characteristic of anxiety disorders, in particular panic disorder, agoraphobia, social phobia, OCD and PTSD. The anxiety score detects the latter anxiety disorders to a slightly greater extent than GAD and specific phobia, without being able to distinguish between the different anxiety disorder types. The cut-off points ≥4 and ≥10 can be used to separate distressed patients in three groups with a relatively low, moderate and high probability of having one or more anxiety disorders.",
author = "B. Terluin and D.B. Oosterbaan and E.P.M. Brouwers and {van Straten}, A.H.M. and {van de Ven}, P. and W. Langerak and {van Marwijk}, H.W.J.",
year = "2014",
doi = "10.1186/1471-244X-14-121",
language = "English",
volume = "14",
journal = "BMC Psychiatry",
issn = "1471-244X",
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To what extent does the anxiety scale of the Four Dimensional Symptom Questionnaire (4DSQ) detect specific types of anxiety disorder in primary care? A psychometric study. / Terluin, B.; Oosterbaan, D.B.; Brouwers, E.P.M.; van Straten, A.H.M.; van de Ven, P.; Langerak, W.; van Marwijk, H.W.J.

In: BMC Psychiatry, Vol. 14, No. 1, 121, 2014.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - To what extent does the anxiety scale of the Four Dimensional Symptom Questionnaire (4DSQ) detect specific types of anxiety disorder in primary care?

T2 - A psychometric study

AU - Terluin, B.

AU - Oosterbaan, D.B.

AU - Brouwers, E.P.M.

AU - van Straten, A.H.M.

AU - van de Ven, P.

AU - Langerak, W.

AU - van Marwijk, H.W.J.

PY - 2014

Y1 - 2014

N2 - BackgroundAnxiety scales may help primary care physicians to detect specific anxiety disorders among the many emotionally distressed patients presenting in primary care. The anxiety scale of the Four-Dimensional Symptom Questionnaire (4DSQ) consists of an admixture of symptoms of specific anxiety disorders. The research questions were: (1) Is the anxiety scale unidimensional or multidimensional? (2) To what extent does the anxiety scale detect specific DSM-IV anxiety disorders? (3) Which cut-off points are suitable to rule out or to rule in (which) anxiety disorders?MethodsWe analyzed 5 primary care datasets with standardized psychiatric diagnoses and 4DSQ scores. Unidimensionality was assessed through confirmatory factor analysis (CFA). We examined mean scores and anxiety score distributions per disorder. Receiver operating characteristic (ROC) analysis was used to determine optimal cut-off points.ResultsTotal n was 969. CFA supported unidimensionality. The anxiety scale performed slightly better in detecting patients with panic disorder, agoraphobia, social phobia, obsessive compulsive disorder (OCD) and post traumatic stress disorder (PTSD) than patients with generalized anxiety disorder (GAD) and specific phobia. ROC-analysis suggested that ≥4 was the optimal cut-off point to rule out and ≥10 the cut-off point to rule in anxiety disorders.ConclusionsThe 4DSQ anxiety scale measures a common trait of pathological anxiety that is characteristic of anxiety disorders, in particular panic disorder, agoraphobia, social phobia, OCD and PTSD. The anxiety score detects the latter anxiety disorders to a slightly greater extent than GAD and specific phobia, without being able to distinguish between the different anxiety disorder types. The cut-off points ≥4 and ≥10 can be used to separate distressed patients in three groups with a relatively low, moderate and high probability of having one or more anxiety disorders.

AB - BackgroundAnxiety scales may help primary care physicians to detect specific anxiety disorders among the many emotionally distressed patients presenting in primary care. The anxiety scale of the Four-Dimensional Symptom Questionnaire (4DSQ) consists of an admixture of symptoms of specific anxiety disorders. The research questions were: (1) Is the anxiety scale unidimensional or multidimensional? (2) To what extent does the anxiety scale detect specific DSM-IV anxiety disorders? (3) Which cut-off points are suitable to rule out or to rule in (which) anxiety disorders?MethodsWe analyzed 5 primary care datasets with standardized psychiatric diagnoses and 4DSQ scores. Unidimensionality was assessed through confirmatory factor analysis (CFA). We examined mean scores and anxiety score distributions per disorder. Receiver operating characteristic (ROC) analysis was used to determine optimal cut-off points.ResultsTotal n was 969. CFA supported unidimensionality. The anxiety scale performed slightly better in detecting patients with panic disorder, agoraphobia, social phobia, obsessive compulsive disorder (OCD) and post traumatic stress disorder (PTSD) than patients with generalized anxiety disorder (GAD) and specific phobia. ROC-analysis suggested that ≥4 was the optimal cut-off point to rule out and ≥10 the cut-off point to rule in anxiety disorders.ConclusionsThe 4DSQ anxiety scale measures a common trait of pathological anxiety that is characteristic of anxiety disorders, in particular panic disorder, agoraphobia, social phobia, OCD and PTSD. The anxiety score detects the latter anxiety disorders to a slightly greater extent than GAD and specific phobia, without being able to distinguish between the different anxiety disorder types. The cut-off points ≥4 and ≥10 can be used to separate distressed patients in three groups with a relatively low, moderate and high probability of having one or more anxiety disorders.

U2 - 10.1186/1471-244X-14-121

DO - 10.1186/1471-244X-14-121

M3 - Article

VL - 14

JO - BMC Psychiatry

JF - BMC Psychiatry

SN - 1471-244X

IS - 1

M1 - 121

ER -