Affiliations: Department of Review and Appeal, The Dutch Institute
for Employee Benefit Schemes, Utrecht, The Netherlands | Department of Psychiatry, VU University Medical
Center/GGZinGeest, Amsterdam, The Netherlands | Department of General Practice and EMGO Institute for
Health and Care Research, VU University Medical Center, Amsterdam, The
Netherlands
Note: [] Address for correspondence: Wendy Langerak, The Dutch Institute
for Employee Benefit Schemes (UWV), Department of Review and Appeal, P.O. Box
2064, 3500 GB Utrecht, The Netherlands. Tel.: +31 627071043; E-mail:
[email protected]
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. Participants: 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.
Keywords: Work disability, mood disorders, anxiety disorders, criterion validity, screening
