title: Validation study of a distress screener.
abstract: OBJECTIVE
  A 3-item screening instrument called the Distress Screener was developed for early identification of distress among employees on sick leave. The Distress Screener consists of three items obtained from the distress subscale of the four-dimensional symptom questionnaire (4DSQ). This study assessed an optimal cut-off point and validated the Distress Screener by relating it to the 4DSQ and to medical diagnoses.
  
  
  METHODS
  171 sick-listed employees filled in the Distress Screener and the 4DSQ (containing four subscales: distress, depression, anxiety and somatisation) and medical diagnoses were obtained from occupational physicians (OPs). The optimal cut-off point was assessed by computing sensitivity and specificity values. Validity was assessed by relating the Distress Screener score to the scores on 4DSQ subscales. In addition scores were compared to mental health medical diagnoses and the degree of similarity between two repeated measurements was obtained.
  
  
  RESULTS
  Using the 4DSQ distress score >10 as reference standard, the optimal cut-off point of the Distress Screener was > or =4. Regarding validity, a high correlation (0.82) existed between the Distress Screener and the 4DSQ distress subscale and it was significantly different from the correlations with the other 4DSQ subscales. Also a high correlation existed for the test-retest reliability (0.83). Furthermore, a high score on the Distress Screener seemed to be related to the medical diagnosis 'Stress-related complaints'. All low scores seemed to be related to the medical diagnosis 'Other complaints'. Sensitivity (0.85) and specificity (0.78) values, and positive and negative predictive values of the screener were comparable to those of the 4DSQ distress subscale.
  
  
  CONCLUSIONS
  The Distress Screener is a valid instrument for use by the OP during consulting time as a quick scan for early identification of distress in employees on sick leave. The cut-off point > or =4 is useful for early identification of distress in employees on sick leave.
authors.affiliation: Department of Public and Occupational Health and The EMGO Institute for Health and Care Research, VU University Medical Centre, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Braam
authors.forename: S H
authors.initials: SH
authors.lastname: van Oostrom
authors.forename: B
authors.initials: B
authors.lastname: Terluin
authors.forename: R
authors.initials: R
authors.lastname: Vasse
authors.forename: H C W
authors.initials: HC
authors.lastname: de Vet
authors.forename: J R
authors.initials: JR
authors.lastname: Anema
mesh_terms: D001007:Anxiety / Q000175:diagnosis*; D003863:Depression / Q000175:diagnosis*; D006801:Humans; D009787:Occupational Medicine; D011594:Psychometrics; D012680:Sensitivity and Specificity; D018582:Sick Leave; D013001:Somatoform Disorders / Q000175:diagnosis*; D013223:Statistics as Topic; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D014938:Work Capacity Evaluation