title: A validation study of the Four-Dimensional Symptom Questionnaire (4DSQ) in insurance medicine.
abstract: OBJECTIVE
  This study aimed to evaluate the criterion validity and the diagnostic accuracy of the Four-Dimensional Symptom Questionnaire (4DSQ) regarding the identification of depressive and anxiety disorders in an insurance medicine setting.
  
  
  METHODS
  Our sample consisted of 230 individuals who applied for a work disability benefit due to mental health problems.
  
  
  METHODS
  Depressive and anxiety disorders were assessed using the 4DSQ and the Composite International Diagnostic Interview (CIDI). Internal consistency was determined by calculating Cronbach's alpha values. Criterion validity was evaluated by regression techniques. A Receiver Operating Characteristic (ROC) analysis was performed to evaluate diagnostic accuracy.
  
  
  RESULTS
  Of the 230 participants 109 (47.4%) had a current DSM-IV depressive disorder and 146 (63.5%) an anxiety disorder. The 4DSQ scales showed an excellent internal consistency. The depression scale of the 4DSQ had specific sensitivity for major depressive disorder. The anxiety scale was also sensitive for the anxiety disorders. The area under the ROC curve (AUC) indicated good diagnostic accuracy of the 4DSQ for assessing depressive and/or anxiety disorders: AUC-value 0.81 for both depression and anxiety.
  
  
  CONCLUSIONS
  Although the 4DSQ shows good criterion validity and diagnostic accuracy with respect to depressive and anxiety disorders in applicants for a work disability benefit due to mental health problems, the feasibility of the 4DSQ as a screening measure for depressive and anxiety disorders is limited due to the high prevalence of depressive and anxiety disorders.
authors.affiliation: Department of Review and Appeal, The Dutch Institute for Employee Benefit Schemes, Utrecht, The Netherlands. wendy.langerak@uwv.nl
authors.forename: Wendy
authors.initials: W
authors.lastname: Langerak
authors.forename: Willie
authors.initials: W
authors.lastname: Langeland
authors.forename: Anton
authors.initials: A
authors.lastname: van Balkom
authors.forename: Stasja
authors.initials: S
authors.lastname: Draisma
authors.forename: Berend
authors.initials: B
authors.lastname: Terluin
authors.forename: Nel
authors.initials: N
authors.lastname: Draijer
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000523:psychology; D019540:Area Under Curve; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000706:statistics & numerical data; D012372:ROC Curve; D012044:Regression Analysis; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D014942:Workers' Compensation