Table of Contents
Background:
Many health care problems in primary care are stress-related (distress) and do not represent true psychiatric disorder (irrespective of whether DSM-IV criteria for depressive or anxiety disorders are fulfilled). Indiscriminate application of DSM-IV criteria in the primary care setting produces many false positive diagnoses confusing patients and misleading professionals.
In health care practice the 4DSQ can be used to:
– help patients acknowledge mental health issues when presenting with physical complaints,
– assess the overall severity of the mental health problems,
– detect depressive and anxiety disorders severe enough to require specific treatment (antidepressants or cognitive behavioral therapy),
– monitor patients’ progress under treatment.
Psychometrics:
The 4DSQ has been extensively tested for reliability and validity. Reliability is high (coefficients generally >.80). Factorial, critirion and concurrant validity has been confirmed.
Author of Tool:
Berend Terluin
Key references:
Terluin B, Van Rhenen W, Schaufeli WB, De Haan M. The Four-Dimensional Symptom Questionnaire (4DSQ): measuring distress and other mental health problems in a working population. Work and Stress 2004; 18(3): 187-207.
Terluin B, Van Marwijk HWJ, Adèr HJ, De Vet HCW, Penninx BWJH, Hermens MLM, Van Boeijen CA, Van Balkom AJLM, Van der Klink JJL, Stalman WAB. The Four-Dimensional Symptom Questionnaire (4DSQ): a validation study of a multidimensional self-report questionnaire to assess distress, depression, anxiety and somatization. BMC Psychiatry 2006; 6:34.
Terluin B, Brouwers EPM, van Marwijk HWJ, Verhaak PFM, van der Horst HE. Detecting depressive and anxiety disorders in distressed patients in primary care; comparative diagnostic accuracy of the Four-Dimensional Symptom Questionnaire (4DSQ) and the Hospital Anxiety and Depression Scale (HADS). BMC Fam Pract 2009; 10:58.
Primary use / Purpose:
The 4DSQ is a self-report questionnaire to assess distress, depression, anxiety and somatization. It is mainly used in primary care. The 4DSQ helps to differentiate between normal distress and psychiatric disorder.
Other Information:
The 4DSQ is free for non-commercial use. Available language versions: English, Dutch, French, German, Polish, Turkish
Four-Dimensional Symptom Questionnaire (4DSQ)
- no
- sometimes
- regularly
- often very often or constantly
During the past week, did you suffer from:
- 1. dizziness or feeling light-headed?
- 2. painful muscles?
- 3. fainting?
- 4. neck pain?
- 5. back pain?
- 6. excessive sweating?
- 7. palpitations?
- 8. headache?
- 9. a bloated feeling in the abdomen?
- 10. blurred vision or spots in front of your eyes?
- 11. shortness of breath?
- 12. nausea or an upset stomach?
During the past week, did you suffer from:
- 13. pain in the abdomen or stomach area?
- 14. tingling in the fingers?
- 15. pressure or a tight feeling in the chest?
- 16. pain in the chest?
- 17. feeling down or depressed?
- 18. sudden fright for no reason?
- 19. worry?
- 20. disturbed sleep?
- 21. a vague feeling of fear?
- 22. lack of energy?
- 23. trembling when with other people?
- 24. anxiety or panic attacks?
During the past week, did you feel:
- 25. tense?
- 26. easily irritated?
- 27. frightened?
During the past week, did you feel:
- 28. that everything is meaningless?
- 29. that you just can’t do anything anymore?
- 30. that life is not worth while?
- 31. that you can no longer take any interest in the people and things around you?
- 32. that you can’t cope anymore?
- 33. that you would be better off if you were dead?
- 34. that you can’t enjoy anything anymore?
- 35. that there is no escape from your situation?
- 36. that you can’t face it anymore?
During the past week, did you:
- 37. no longer feel like doing anything?
- 38. have difficulty in thinking clearly?
- 39. have difficulty in getting to sleep?
- 40. have any fear of going out of the house alone?
During the past week:
- 41. did you easily become emotional?
- 42. were you afraid of anything when there was really no need for you to be afraid? (for instance animals, heights, small rooms)
- 43. were you afraid to travel on buses, streetcars/ trams, subways or trains?
- 44. were you afraid of becoming embarrassed when with other people?
- 45. did you ever feel as if you were being threatened by unknown danger?
- 46. did you ever think “I wish I was dead”?
- 47. did you ever have fleeting images of any upsetting event(s) that you have experienced?
- 48. did you ever have to do your best to put aside thoughts about any upsetting event(s)?
- 49. did you have to avoid certain places because they frightened you?
- 50. did you have to repeat some actions a number of times before you could do something else?
4DSQ scoring form
- ‘no’ = score 0 ‘sometimes’ = score 1
- ‘regularly’ or more often = score 2
Distress Depression Anxiety Somatisation
- Interpretation:
- moderately elevated: > 10 > 2 > 8 > 10
- strongly elevated: > 20 > 5 > 12 > 20