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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

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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

Berend Terluin et al. BMC Psychiatry.

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.

Figures

Figure 1
Figure 1
Disorder-specific 4DSQ anxiety score distributions. Separate boxplots for specific phobia (SPEC), generalized anxiety disorder (GAD), social phobia (SOC), panic disorder (PAN), agoraphobia (AGO), obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD). The boxes of the boxplots represent the median scores and the interquartile ranges. The whiskers of the plots reach to the extreme scores.
Figure 2
Figure 2
4DSQ anxiety score distributions by number of anxiety disorders per patient. The boxes of the boxplots represent the median scores and the interquartile ranges (IQR). The whiskers of the plots reach to the extreme scores, with a maximum distance to the box of 1.5 IQR. Outliers are represented by dots (distance to the box of 1.5-3 IQR) or asterisks (distance to the box of >3 IQR).
Figure 3
Figure 3
4DSQ anxiety score distributions by comorbidity groups. The boxes of the boxplots represent the median scores and the interquartile ranges (IQR). The whiskers of the plots reach to the extreme scores, with a maximum distance to the box of 1.5 IQR. Outliers are represented by dots (distance to the box of 1.5-3 IQR) or asterisks (distance to the box of >3 IQR).

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