title: Distinguishing between emotional distress and psychiatric disorder in primary care attenders: A cross sectional study of the four-dimensional symptom questionnaire (4DSQ).
abstract: BACKGROUND
  Detection of psychiatric disorder in primary care is a complex issue. Distinctions between 'normal' emotional distress and psychiatric disorder depend on how disorder is conceptualized. Our aim was to explore two different conceptualizations by examining patients' scores on one-dimensional depression measures and scores on the Four Dimensional Symptom Questionnaire (4DSQ), a measure that uniquely has separate dimensions for general distress and depressive disorder.
  
  
  METHODS
  This was a cross sectional study of 487 primary care patients attending general clinics in Hampshire, UK. Patients completed the 4DSQ, Patient Health Questionnaire-9 (PHQ-9), General Health Questionnaire-12 (GHQ-12) and the Hospital Anxiety and Depression Scale (HADS) whilst in the waiting room.
  
  
  RESULTS
  The 4DSQ classified 26% (126/485) of patients as having heightened distress levels and 8% (38/468) as possible cases of depressive disorder. Casesness was consistently higher across the one-dimensional measures (PHQ-9: 16%, GHQ-12: 28%, HADS-D: 13%). Of those patients deemed possible cases by the PHQ-9 (≥ 10), the 4DSQ classified 91% (71/78) as having heightened distress and 44% (32/72) as possible cases of depressive disorder.
  
  
  CONCLUSIONS
  The sample was predominately older and white, which may limit generalizability of the findings to more diverse patient groups. There are limits to self-report measures in the assessment of complex diagnostic issues.
  
  
  CONCLUSIONS
  Inclusion of a distinct general distress dimension alongside a dimension focusing on specific depression symptomatology lowered the number of primary care patients classified as possible cases of disorder. This view of symptoms may have implications for the targeting of existing treatments, and may be useful in guiding the development of novel self-management interventions.
authors.affiliation: Primary Care and Population Sciences, University of Southampton, United Kingdom. Electronic address: A.W.Geraghty@soton.ac.uk.
authors.forename: Adam W A
authors.initials: AW
authors.lastname: Geraghty
authors.affiliation: Primary Care and Population Sciences, University of Southampton, United Kingdom.
authors.forename: Beth
authors.initials: B
authors.lastname: Stuart
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Berend
authors.initials: B
authors.lastname: Terluin
authors.affiliation: Primary Care and Population Sciences, University of Southampton, United Kingdom.
authors.forename: Tony
authors.initials: T
authors.lastname: Kendrick
authors.affiliation: Primary Care and Population Sciences, University of Southampton, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.affiliation: Primary Care and Population Sciences, University of Southampton, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Moore
mesh_terms: D000342:Affective Symptoms / Q000175:diagnosis* / Q000523:psychology; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology; D008875:Middle Aged; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Assessment; Depression; Distress; Primary care