title: Distress or no distress, that's the question: A cutoff point for distress in a working population.
abstract: BACKGROUND
  The objective of the present study is to establish an optimal cutoff point for distress measured with the corresponding scale of the 4DSQ, using the prediction of sickness absence as a criterion. The cutoff point should result in a measure that can be used as a credible selection instrument for sickness absence in occupational health practice and in future studies on distress and mental disorders.
  
  
  METHODS
  Distress is measured using the Four Dimensional Symptom Questionnaire (4DSQ), a 50-item self-report questionnaire, in a working population with and without sickness absence due to distress. Sensitivity and specificity were compared for various potential cutoff points, and a receiver operating characteristics analysis was conducted.
  
  
  CONCLUSIONS
  A distress cutoff point of >/=11 was defined. The choice was based on a challenging specificity and negative predictive value and indicates a distress level at which an employee is presumably at risk for subsequent sick leave on psychological grounds. The defined distress cutoff point is appropriate for use in occupational health practice and in studies of distress in working populations.
authors.affiliation: Academic Medical Center, Coronel Institute of Occupational Health, University of Amsterdam, Amsterdam, The Netherlands. willem.van.rhenen@arboned.nl.
authors.forename: Willem
authors.initials: W
authors.lastname: van Rhenen
authors.forename: Frank Jh
authors.initials: FJ
authors.lastname: van Dijk
authors.forename: Wilmar B
authors.initials: WB
authors.lastname: Schaufeli
authors.forename: Roland Wb
authors.initials: RW
authors.lastname: Blonk