Journal of Occupational Rehabilitation

, Volume 25, Issue 1, pp 105–115 | Cite as

Validation of the 4DSQ Somatization Subscale in the Occupational Health Care Setting as a Screener

  • Lars de Vroege
  • Wilco H. M. Emons
  • Klaas Sijtsma
  • Rob Hoedeman
  • Christina M. van der Feltz-Cornelis


Purpose Somatoform disorders (physical symptoms without medical explanation that cause dysfunction) are prevalent in the occupational health (OH) care setting and are associated with functional impairment and absenteeism. Availability of psychometric instruments aimed at assessing somatoform disorders is limited. In the OH setting, so far only the Patient-Health-Questionnaire 15 has been validated as screener for somatoform disorder, and has been shown to have moderate validity. The Four-Dimensional Symptom Questionnaire (4DSQ) is frequently used in the OH setting but the Somatization subscale is not validated yet. The aim of this study is to validate the 4DSQ Somatization subscale as screener for DSM-IV somatoform disorder in the OH setting by using the MINI interview as gold standard. Methods Employees absent from work due to physical symptoms, for a period longer than 6 weeks and shorter than 2 years, were asked to participate in this study. They filled out the 4DSQ and underwent a MINI interview by telephone for DSM-IV classification. Specificity and sensitivity scores were calculated for all possible cut-off scores and a receiver operator curve was computed for the Somatization subscale. 95 % confidence intervals (95 % CIs) were calculated for sensitivity and specificity. Results The Somatization subscale of the 4DSQ has an optimal cut point of 9, with specificity and sensitivity equal to 64.3 % [95 % CI (53.6; 73.7 %)] and 60.9 % [95 % CI (40.8; 77.8 %)], respectively. Receiver operator curves showed an area under the curve equal to 0.61 [SE = 0.07; 95 % CI (0.48; 0.75)] for the Somatization subscale of the 4DSQ. Conclusion The 4DSQ Somatization subscale is a questionnaire of moderate sensitivity and specificity.


Four-Dimensional Symptom Questionnaire Somatoform disorders Occupational health setting Sensitivity Specificity 



The authors of this article would like to thank Melanie de Ruiter for doing the MINI interviews on this project, and Jasper Nuijen for his assistance in data management.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Lars de Vroege
    • 1
    • 2
  • Wilco H. M. Emons
    • 3
  • Klaas Sijtsma
    • 3
  • Rob Hoedeman
    • 4
    • 5
  • Christina M. van der Feltz-Cornelis
    • 1
    • 2
    • 6
  1. 1.Tranzo Department, Tilburg School of Behavioral and Social SciencesTilburg UniversityTilburgThe Netherlands
  2. 2.Clinical Centre for Body, Mind and HealthGGz BreburgTilburgThe Netherlands
  3. 3.Department of Methodology and StatisticsTilburg UniversityTilburgThe Netherlands
  4. 4.Department of Health SciencesUniversity Medical Center of GroningenGroningenThe Netherlands
  5. 5.Department of ScienceArboNed Occupational Health ServicesUtrechtThe Netherlands
  6. 6.Trimbos Institute, Netherlands Institute of Mental Health and AddictionUtrechtThe Netherlands

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