Four-Dimensional Symptom Questionnaire – 4DSQ
A self-report instrument designed to identify and distinguish between distress, depression, anxiety, and somatization in primary care settings.
Scale Development & Technical Details
Scale Overview
The Four-Dimensional Symptom Questionnaire – 4DSQ was developed by Berend Terluin (2004). It is designed to measure Distress, Depression, Anxiety, Somatization. The scale is intended for use with Adults (primarily primary care patients).
Scale Structure
This instrument consists of 50 items organized into 4 factors/subscales: Somatization, Distress, Depression, Anxiety.
| Factor / Subscale | Items | N |
|---|---|---|
| Somatization | 1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16 | 16 |
| Distress | 17,19,20,22,25,26,29,31,32,37,38,39,41,46,47,48 | 16 |
| Depression | 28,30,33,34,35,36 | 6 |
| Anxiety | 18,21,23,24,27,40,42,43,44,45,49,50 | 12 |
Response Format
Respondents rate each item using a custom response format.
Response anchors: 0 = No, 1 = Sometimes, 2 = Regularly, often, very often, or constantly.
Scoring
Items are scored by subscale, with each subscale sum representing a distinct dimension.
Total scores range from 0 to 32. Interpretation guidelines:
- Distress: Low/Normal: 0 – 10
- Distress: Moderately Elevated: 11 – 20
- Distress: Strongly Elevated: 21 – 32
- Depression: Low/Normal: 0 – 2
- Depression: Moderately Elevated: 3 – 5
- Depression: Strongly Elevated: 6 – 12
- Anxiety: Low/Normal: 0 – 8
- Anxiety: Moderately Elevated: 9 – 12
- Anxiety: Strongly Elevated: 13 – 24
- Somatization: Low/Normal: 0 – 10
- Somatization: Moderately Elevated: 11 – 20
- Somatization: Strongly Elevated: 21 – 32
Psychometric Properties
Internal Consistency: The scale has demonstrated good to excellent internal consistency with reported Cronbach’s alpha values of Cronbach's alpha > .80.
Administration
The scale is self-administered and typically takes approximately 10 minutes to complete. It can be administered individually or in group settings. No special training is required for administration.