Background
Methods
Patients and procedure
Measurements
Instrument | Scale | Lower cut-off point | Higher cut-off point |
---|---|---|---|
4DSQ | depression | ≥3 | ≥6 |
anxiety | ≥8 | ≥13 | |
HADS | depression | ≥8 | ≥11 |
anxiety | ≥8 | ≥11 |
Analysis
Results
Description of the sample
questionnaire scales | ||||||
---|---|---|---|---|---|---|
Diagnoses | number of patients (%) | 4DSQ distress (α 0.90) | 4DSQ depression (α 0.86) | 4DSQ anxiety (α 0.86) | HADS depression (α 0.83) | HADS anxiety (α 0.78) |
Major depression | 146 (49) | 26.2 (4.9) | 5.3 (3.3) | 7.6 (5.5) | 12.7 (3.4) | 13.0 (3.7) |
- mild | 68 (23) | 24.7 (5.2) | 4.0 (2.7) | 5.4 (4.7) | 12.0 (3.3) | 11.3 (3.4) |
- moderate | 36 (12) | 26.4 (4.7) | 5.3 (3.3) | 8.7 (5.5) | 12.5 (3.6) | 13.7 (3.0) |
- severe | 42 (14) | 28.4 (3.4) | 7.5 (3.2) | 10.2 (5.4) | 14.1 (3.1) | 15.0 (3.4) |
Anxiety disorder | 99 (34) | 26.6 (5.2) | 5.6 (3.4) | 9.5 (5.5) | 12.5 (3.4) | 14.0 (3.2) |
- generalized anxiety disorder | 61 (21) | 26.7 (4.9) | 5.7 (3.3) | 8.3 (5.4) | 12.3 (3.0) | 13.9 (3.1) |
- panic disorder w/o agoraphobia | 12 (4) | 27.5 (4.5) | 6.8 (3.8) | 10.3 (3.5) | 12.0 (3.8) | 15.7 (2.7) |
- panic disorder w/ agoraphobia | 11 (4) | 24.7 (5.8) | 5.5 (3.4) | 13.8 (4.7) | 12.8 (3.9) | 14.2 (3.9) |
- agoraphobia w/o panic disorder | 10 (3) | 25.4 (8.2) | 4.1 (3.2) | 11.4 (7.6) | 13.8 (4.6) | 13.8 (3.9) |
- social phobia | 32 (11) | 28.4 (3.6) | 6.1 (3.1) | 12.4 (5.5) | 13.4 (3.8) | 14.8 (3.0) |
No depressive or anxiety disorder | 115 (39) | 18.3 (7.4) | 2.2 (2.8) | 3.3 (4.0) | 8.1 (4.2) | 9.4 (3.7) |
ROC analyses
Diagnostic categories/levels | 4DSQ scale | HADS scale | Z/p |
---|---|---|---|
Any depressive/anxiety disorder | distress | total score | |
AUC 0.792 se 0.027 | AUC 0.815 se 0.027 | Z 0.525 p 0.596 | |
Major depressive disorder | depression | depression | |
- any major depressive disorder | AUC 0.745 se 0.029 | AUC 0.762 se 0.028 | Z 0.574 p 0.569 |
- moderate-severe major depressive disorder | AUC 0.780 se 0.029 | AUC 0.739 se 0.030 | Z 1.389 p 0.165 |
Anxiety disorder | anxiety | anxiety | |
- any anxiety disorder | AUC 0.792 se 0.028 | AUC 0.757 se 0.028 | Z 1.333 p 0.184 |
- panic disorder/agoraphobia/social phobia | AUC 0.852 se 0.024 | AUC 0.757 se 0.032 | Z 3.294
p 0.001
|
Sensitivity, specificity, PPV and NPV
4DSQ distress
| sensitivity | specificity | PPV | NPV |
---|---|---|---|---|
≥16 | 0.95 | 0.37 | 0.70 | 0.83 |
≥17 | 0.94 | 0.43 | 0.72 | 0.82 |
≥18 | 0.93 | 0.47 | 0.73 | 0.81 |
≥19 | 0.91 | 0.55 | 0.76 | 0.79 |
≥20
|
0.90
| 0.56 | 0.76 |
0.78
|
≥21 | 0.84 | 0.57 | 0.76 | 0.70 |
≥22 | 0.77 | 0.67 | 0.78 | 0.65 |
≥23 | 0.75 | 0.67 | 0.78 | 0.63 |
≥24
|
0.71
|
0.73
| 0.80 | 0.61 |
≥25 | 0.65 | 0.77 | 0.82 | 0.59 |
≥26 | 0.61 | 0.80 | 0.83 | 0.57 |
≥27 | 0.56 | 0.84 | 0.85 | 0.55 |
≥28
| 0.48 |
0.85
|
0.83
| 0.51 |
≥29 | 0.36 | 0.90 | 0.85 | 0.48 |
≥30 | 0.28 | 0.94 | 0.88 | 0.46 |
≥31 | 0.19 | 0.97 | 0.90 | 0.43 |
HADS total score
| ||||
≥16 | 0.96 | 0.41 | 0.72 | 0.86 |
≥17 | 0.93 | 0.46 | 0.73 | 0.80 |
≥18 | 0.92 | 0.50 | 0.74 | 0.80 |
≥19 | 0.89 | 0.59 | 0.77 | 0.78 |
≥20
|
0.86
| 0.64 | 0.79 |
0.74
|
≥21 | 0.82 | 0.68 | 0.80 | 0.71 |
≥22
|
0.76
|
0.75
| 0.82 | 0.66 |
≥23 | 0.71 | 0.80 | 0.85 | 0.64 |
≥24 | 0.63 | 0.84 | 0.86 | 0.59 |
≥25
| 0.56 |
0.85
|
0.85
| 0.55 |
≥26 | 0.46 | 0.88 | 0.85 | 0.51 |
≥27 | 0.39 | 0.89 | 0.84 | 0.48 |
≥28 | 0.32 | 0.91 | 0.85 | 0.46 |
≥29 | 0.27 | 0.92 | 0.84 | 0.45 |
≥30 | 0.21 | 0.95 | 0.86 | 0.43 |
4DSQ depression
| sensitivity | specificity | PPV | NPV |
---|---|---|---|---|
≥1 | 0.96 | 0.34 | 0.59 | 0.89 |
≥2
|
0.88
| 0.46 | 0.62 |
0.80
|
≥3 | 0.78 | 0.60 | 0.66 | 0.74 |
≥4
|
0.65
|
0.72
| 0.69 | 0.68 |
≥5 | 0.53 | 0.79 | 0.71 | 0.63 |
≥6 | 0.45 | 0.83 | 0.71 | 0.60 |
≥7
| 0.32 |
0.87
|
0.71
| 0.57 |
≥8 | 0.25 | 0.92 | 0.75 | 0.56 |
≥9 | 0.18 | 0.93 | 0.72 | 0.54 |
≥10 | 0.12 | 0.97 | 0.78 | 0.53 |
HADS depression
| ||||
≥7 | 0.97 | 0.30 | 0.57 | 0.92 |
≥8 | 0.93 | 0.39 | 0.60 | 0.84 |
≥9
|
0.88
| 0.49 | 0.63 |
0.81
|
≥10 | 0.84 | 0.60 | 0.68 | 0.80 |
≥11
|
0.75
|
0.67
| 0.69 | 0.73 |
≥12 | 0.60 | 0.75 | 0.70 | 0.65 |
≥13 | 0.49 | 0.78 | 0.69 | 0.61 |
≥14
| 0.40 |
0.88
|
0.77
| 0.60 |
≥15 | 0.32 | 0.89 | 0.73 | 0.57 |
≥16 | 0.21 | 0.93 | 0.74 | 0.55 |
≥17 | 0.16 | 0.96 | 0.79 | 0.54 |
4DSQ depression
| sensitivity | specificity | PPV | NPV |
---|---|---|---|---|
≥2 | 0.96 | 0.38 | 0.36 | 0.97 |
≥3
|
0.87
| 0.52 | 0.39 |
0.92
|
≥4 | 0.78 | 0.65 | 0.45 | 0.89 |
≥5
|
0.64
|
0.73
| 0.46 | 0.85 |
≥6 | 0.59 | 0.79 | 0.51 | 0.84 |
≥7
| 0.46 |
0.87
|
0.55
| 0.82 |
≥8 | 0.39 | 0.91 | 0.61 | 0.81 |
≥9 | 0.27 | 0.93 | 0.58 | 0.78 |
≥10 | 0.21 | 0.97 | 0.70 | 0.77 |
HADS depression
| ||||
≥8 | 0.96 | 0.30 | 0.33 | 0.96 |
≥9 | 0.91 | 0.38 | 0.35 | 0.92 |
≥10
|
0.87
| 0.48 | 0.37 |
0.91
|
≥11 | 0.81 | 0.56 | 0.40 | 0.89 |
≥12
|
0.64
|
0.65
| 0.40 | 0.84 |
≥13 | 0.56 | 0.72 | 0.42 | 0.82 |
≥14 | 0.49 | 0.82 | 0.49 | 0.82 |
≥15
| 0.39 |
0.85
|
0.48
| 0.79 |
≥16 | 0.27 | 0.90 | 0.50 | 0.77 |
≥17 | 0.22 | 0.95 | 0.59 | 0.77 |
4DSQ anxiety
| sensitivity | specificity | PPV | NPV |
---|---|---|---|---|
≥1 | 0.98 | 0.20 | 0.38 | 0.95 |
≥2 | 0.94 | 0.33 | 0.41 | 0.91 |
≥3 | 0.90 | 0.45 | 0.45 | 0.90 |
≥4
|
0.85
| 0.57 | 0.50 |
0.88
|
≥5 | 0.75 | 0.64 | 0.51 | 0.83 |
≥6
|
0.70
|
0.72
| 0.56 | 0.82 |
≥7 | 0.67 | 0.78 | 0.60 | 0.82 |
≥8 | 0.65 | 0.84 | 0.67 | 0.82 |
≥9
| 0.59 |
0.88
|
0.71
| 0.81 |
≥10 | 0.54 | 0.90 | 0.73 | 0.79 |
≥11 | 0.40 | 0.91 | 0.70 | 0.75 |
≥12 | 0.32 | 0.93 | 0.71 | 0.73 |
≥13 | 0.24 | 0.94 | 0.67 | 0.71 |
≥14 | 0.20 | 0.95 | 0.67 | 0.70 |
HADS anxiety
| ||||
≥8 | 0.98 | 0.27 | 0.40 | 0.96 |
≥9 | 0.98 | 0.35 | 0.43 | 0.97 |
≥10
|
0.91
| 0.43 | 0.45 |
0.90
|
≥11 | 0.84 | 0.51 | 0.46 | 0.86 |
≥12 | 0.78 | 0.63 | 0.51 | 0.85 |
≥13
|
0.65
|
0.70
| 0.52 | 0.80 |
≥14 | 0.58 | 0.78 | 0.57 | 0.78 |
≥15 | 0.47 | 0.83 | 0.58 | 0.75 |
≥16
| 0.32 |
0.89
|
0.59
| 0.72 |
≥17 | 0.21 | 0.93 | 0.62 | 0.70 |
≥18 | 0.15 | 0.97 | 0.71 | 0.69 |
4DSQ anxiety
| sensitivity | specificity | PPV | NPV |
---|---|---|---|---|
≥4 | 0.98 | 0.53 | 0.33 | 0.99 |
≥5 | 0.89 | 0.61 | 0.35 | 0.96 |
≥6
|
0.86
| 0.68 | 0.39 |
0.95
|
≥7 | 0.82 | 0.73 | 0.42 | 0.95 |
≥8
|
0.79
|
0.78
| 0.46 | 0.94 |
≥9 | 0.71 | 0.82 | 0.49 | 0.92 |
≥10
| 0.64 |
0.85
|
0.49
| 0.91 |
≥11 | 0.54 | 0.89 | 0.53 | 0.89 |
≥12 | 0.43 | 0.91 | 0.53 | 0.87 |
≥13 | 0.32 | 0.93 | 0.50 | 0.85 |
≥14 | 0.27 | 0.94 | 0.50 | 0.85 |
≥15 | 0.23 | 0.96 | 0.56 | 0.84 |
HADS anxiety
| ||||
≥8 | 1.00 | 0.23 | 0.23 | 1.00 |
≥9 | 1.00 | 0.29 | 0.25 | 1.00 |
≥10 | 0.95 | 0.38 | 0.26 | 0.97 |
≥11
|
0.86
| 0.45 | 0.27 |
0.93
|
≥12 | 0.80 | 0.56 | 0.30 | 0.92 |
≥13
|
0.68
|
0.65
| 0.31 | 0.90 |
≥14 | 0.63 | 0.73 | 0.35 | 0.89 |
≥15 | 0.57 | 0.80 | 0.40 | 0.89 |
≥16
| 0.41 |
0.87
|
0.43
| 0.86 |
≥17 | 0.27 | 0.92 | 0.44 | 0.84 |
≥18 | 0.20 | 0.96 | 0.52 | 0.84 |