Distinguishing emotional distress from mental disorder: a qualitative exploration of the Four-Dimensional Symptom Questionnaire (4DSQ)

Background: Primary care clinicians see people experiencing the full range of mental health problems. Determining when symptoms reflect disorder is complex. The Four-Dimensional Symptom Questionnaire (4DSQ) uniquely distinguishes general distress from depressive and anxiety disorders. It may support diagnostic conversations and targeting of treatment.

Aim: We aimed to explore peoples’ experiences of completing the 4DSQ and their perceptions of their resulting score profile across distress, depression, anxiety and physical symptoms.

Design and Setting: A qualitative study conducted in the UK with people recruited from primary care and community settings.

Method: Participants completed the 4DSQ then took part in semi-structured telephone interviews. They were interviewed about their experience of completing the 4DSQ, their perceptions of their scores across four dimensions, and the perceived utility if used with a clinician. Interviews were transcribed verbatim and data were analysed thematically.

Results: Twenty-four interviews were conducted. Most participants found the 4DSQ easy to complete and reported that scores across the four dimensions aligned well with their symptom experience. Distinct scores for distress, depression and anxiety appeared to support improved self-understanding. Some valued the opportunity to discuss their scores and provide relevant context. Many felt the use of the 4DSQ with clinicians would be helpful and likely to support treatment decisions, although some were concerned about time-limited consultations.

Conclusion: Distinguishing general distress from depressive and anxiety disorders aligned well with people’s experience of symptoms. Use of the 4DSQ as part of mental health consultations may support targeting of treatment and personalisation of care.