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.

Detection of Anxiety Disorders in Primary Care: A Meta-Analysis of Assisted and Unassisted Diagnoses

“…An improved understanding of GPs' diagnostic accuracy of anxiety disorders is a fundamental step in building better access to care and treatment for patients with anxiety disorders in PHC. Anxiety scales may help GPs to detect specific anxiety disorders [34,35] , but evidence of the added value of their use over routine clinical judgment is limited. We, therefore, performed a systematic review of data on accuracy of assisted and unassisted diagnoses of anxiety disorders by GPs, worldwide, in adults and children/adolescents.…”

The Four-Dimensional Symptom Questionnaire (4DSQ) in the general population: scale structure, reliability, measurement invariance and normative data: a cross-sectional survey

“…The anxiety scale measures symptoms that are relatively specific to anxiety disorder [ 6 ]. Scores on the 4DSQ depression and anxiety scales indicate the likelihood of a (DSM-IV) depressive or anxiety disorder [ 7 , 8 ]. The somatization scale measures symptoms of somatic distress and somatoform disorder [ 9 , 10 ].…”

Is there a burden attached to synaesthesia? Health screening of synaesthetes in the general population

“…Anxiety is a heterogeneous condition exhibiting a wide range of symptom dimensions (Terluin et al, 2014), including panic disorder, generalized anxiety disorder, and specific phobias. Anxiety is a heterogeneous condition exhibiting a wide range of symptom dimensions (Terluin et al, 2014), including panic disorder, generalized anxiety disorder, and specific phobias.…”

“…Since our study revealed a significant comorbidity between grapheme-colour synaesthesia and anxiety disorder, we look to possible neural or genetic overlaps between the two conditions. Anxiety is a heterogeneous condition exhibiting a wide range of symptom dimensions (Terluin et al, 2014), including panic disorder, generalized anxiety disorder, and specific phobias. This heterogeneity is reflected in the brain imaging literature on anxiety disorder, with different regions implicated in different underlying behaviours (Duval, Javanbakht, & Liberzon, 2015).…”