The four-Dimensional Symptom Questionnaire (4DSQ) as a tool to detect and diagnose anxiety and depressive disorders in patients with a 'nervous breakdown'.

Background: Distressed patients in general practice often describe their problem as a 'nervous breakdown' caused by too much stress. Dutch GPs use an equivalent Dutch word as a diagnosis for this condition when the symptoms are largely non-specific but severe enough to cause social diasbility, and when there is a direct relationship with major stressors. However, some of these patients actually have severe anxiety and/or depressive symptoms suggesting a DSM-IV defined disorder. The Four-Dimensional Symptom Questionnaire (4DSQ) had been developed to measure four important symptom dimensions, i.e. distress, depression, anxiety and somatization. The Depression and Anxiety scales contain symptoms that are characteristic of depressive and anxiety disorders. The Distress scale contains the non-specific psychological symptoms that are characteristic of 'nervous breakdown'. Objectives: To demonstrate the value of the 4DSQ as a tool for the detection and diagnosis of anxiety and depressive disorders in 'nervous breakdown' patients. Method: Seventy GPs in Almere, the Netherlands, recruited patients ageds 18 to 60 with a 'nervous breakdown', who had a job and were on sick leave. The patients filled in the 4DSQ and received a standardized psychiatric interview, the Composite International Diagnostic Interview (CIDI), to determine dsm-iv disorders. Logistic regression analysis was used to estimate the probabilities of having an anxiety or depressive disorder depending on the 4DSQ Anxiety and Depression scores. Results: A total of 306 patients were interviewed, 184 women with a mean age of 38,5 years (SD 9.4) and 112 men with a mean age of 40,8 years (SD 8.8) . The 4DSQ was filled in by 294 patients. 156 patients (51%) had a major depression: 106 patients (35%) had an anxiety disorder; 115 patients (38%) had no anxiety disorder or major depression. An Anxiety score 70% of having an anxiety disorder, that was in most cases a panic of phobic disorder. A Depression score 6 indicated a probability of > 65% of having a major depression, that was moderate or severe in most cases. Discussion: We recommend the use of two cut-off points for each scale: a low cut-off point with a high sensitivity to exclude an anxiety or depressive disorder (for the time being), and a higher cut-off point with a high specificity to prompt the physician to make a clinical diagnosis according to accept clinical criteria. Patients scoring in between the cut-off points should be followed up carefully for 2-4 weeks to see how the symptoms develop. By sorting out patients with low, intermediate and high probalilities of having an anxiety or depressive disorder, the 4DSQ enables GPs to target their diagnostic efforts to the appropriate patients. (aut.ref.