Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
Department of Clinical Psychology and Psychotherapy, Philipps-University, Marburg, Germany.
Psychol Health Med. 2021 Jan-Dec;26(sup1):1-19. doi: 10.1080/13548506.2021.1883685. Epub 2021 Apr 9.
Mental health problems are highly prevalent in primary care. Validated tools to detect mental disorders in general practice are needed. The Four-Dimensional Symptom Questionnaire (4DSQ) was designed to help GPs differentiating between psychological distress and psychopathological conditions (depression, anxiety, somatization). The aim of the current study was to examine psychometric properties of the 4DSQ in a mental health setting. Reliability, factorial, construct, and criterion validity of the English translation of the 4DSQ were analyzed in an American sample of 159 patients attending a psychotherapy outpatient clinic. Measurement equivalence across languages was determined by analyzing differential item functioning (DIF) and differential test functioning (DTF) in the American sample and a Dutch mental health sample, matched by age and sex. A confirmatory factor analysis confirmed all 4DSQ subscales to be unidimensional. All 4DSQ subscales revealed excellent reliability (Cronbach's alpha and McDonald omega ≥.90) and high correlations with a symptom distress subscale of an instrument that is commonly used to monitor psychotherapy progress, the Outcome Questionnaire-45. Eight items were flagged with DIF. The Depression subscale was free of DIF. DTF analyses showed an impact of DIF on scale level for the lower cutoff score of the Distress scale. The 4DSQ Distress score was the best predictor of a mood disorder diagnosis and the Anxiety score outperformed other 4DSQ scales to predict an anxiety disorder. In conclusion, the 4DSQ demonstrates excellent reliability and validity in a mental health setting. Further research is needed to determine reliable cutoff values on 4DSQ subscales to predict psychiatric diagnoses.
精神健康问题在初级保健中非常普遍。需要有效的工具来检测一般实践中的精神障碍。四维度症状问卷（4DSQ）旨在帮助全科医生区分心理困扰和精神病理状况（抑郁、焦虑、躯体化）。本研究的目的是在心理健康环境中检验 4DSQ 的心理测量特性。对参加心理治疗门诊的 159 名美国患者的样本进行了 4DSQ 英语翻译的可靠性、因子、结构和标准有效性分析。通过分析美国样本和荷兰心理健康样本的差异项目功能（DIF）和差异测试功能（DTF），确定了语言之间的测量等效性，这些样本按年龄和性别匹配。验证性因子分析证实了 4DSQ 的所有子量表都是单维的。所有 4DSQ 子量表的可靠性都很高（Cronbach's alpha 和 McDonald omega≥.90），与常用于监测心理治疗进展的工具的症状困扰子量表高度相关，即结果问卷-45。有 8 个项目存在 DIF。抑郁子量表没有 DIF。DTF 分析显示，在较低的困扰量表截断值水平上，DIF 对量表水平有影响。4DSQ 困扰得分是预测心境障碍诊断的最佳预测因子，焦虑得分优于其他 4DSQ 量表，可预测焦虑障碍。总之，4DSQ 在心理健康环境中具有良好的可靠性和有效性。需要进一步研究来确定 4DSQ 子量表的可靠截断值，以预测精神科诊断。
