Four Dimensional Symptom Questionnaire (4DSQ)

Dutch: Vierdimensionale Klachtenlijst (4DKL)

Introduction
The 4DSQ is a self-rating questionnaire measuring four dimensions of common psychopathology: distress, depression, anxiety and somatization. The 4DSQ was developed in general practice. The principal aim of the 4DSQ is to distinguish between stress-related syndromes (denoted as ‘stress’, ‘burnout’, ‘nervous breakdown’ or in Dutch ‘overspanning’ or ‘surmenage’) and psychiatric disorders (i.e. depression and anxiety disorders).

Content
The Distress scale measures nonspecific symptoms of psychopathology, ranging from worrying and irritability to fatigue and demoralization. As a general nonspecific component distress is always part of the symptomatology of anxiety and depressive disorders, in which case distress accompanies specific symptoms of anxiety or depression. Distress alone, or in combination with somatization, is characteristic of uncomplicated stress-related syndromes that are commonly encountered in general practice. The Distress score is associated with any psychosocial problem as established by general practitioners (GPs) in general practice patients.

The Depression scale measures severe anhedonia and depressive thoughts, including suicidal ideation, symptoms that are characteristic of depressive disorders. The Depression score indicates the probability of having a major depressive disorder.

The Anxiety scale measures free floating anxiety, panic, and phobic anxiety, symptoms that are specific to the anxiety disorders. The Anxiety score indicates the probability of having one or more anxiety disorders.

The Somatization scale measures a range of common physical symptoms, known to be related to distress or psychopathology. Examples are headache, palpitations, nausea, and muscle aches. Moderate levels of somatization commonly accompany psychological distress that is not necessarily pathologic. High levels of somatization reflect pathological psychological mechanisms in which worries about possible physical illness and selective attention to physical symptoms are important. The Somatization score is associated with the GP’s suspicion of a psychosocial background in patients presenting with physical symptoms.

Psychometric properties
Reliability of the 4DSQ scales is high with alpha-coefficients ranging from 0.84 to 0.94 and test-retest coefficients ranging from 0.89 to 0.94. The correlations between the 4DSQ-scales range from 0.35 to 0.71. The four-factor structure of the 4DSQ has been confirmed.

Applications
The 4DSQ can be used both in clinical practice, especially in general practice and occupational medicine, as well as in research.

Distribution
The 4DSQ is freely available for non-commercial use in clinical practice and research. People who wish to make commercial use of the 4DSQ are invited to contact the author [b.terluin@vumc.nl]. We would appreciate it when potential 4DSQ-users state their name, profession, address and intended use of the 4DSQ.

Documentation

1. 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.

2. 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 Stress 2004, 18:187-207.

3. Terluin B, Duijsens IJ: 4DKL-handleiding. Handleiding van de Vierdimensionale Klachtenlijst [4DSQ manual. Manual of the Four-Dimensional Symptom Questionnaire]. Leiderdorp: Datec; 2002.

4. Terluin B: De Vierdimensionale Klachtenlijst (4DKL). Een vragenlijst voor het meten van distress, depressie, angst en somatisatie [The Four-Dimensional Symptom Questionnaire (4DSQ). A questionnaire to measure distress, depression, anxiety, and somatization]. Huisarts Wet 1996, 39:538-547.

5. Terluin B: De Vierdimensionale Klachtenlijst (4DKL) in de huisartspraktijk. [The Four-Dimensional Symptom Questionnaire (4DSQ) in general practice]. De Psycholoog 1998, 33:18-24.

6. Terluin B: Wat meet de Vierdimensionale Klachtenlijst (4DKL) in vergelijking met enkele bekende klachtenlijsten? [The Four-Dimensional Symptom Questionnaire (4DSQ) compared with some well-known symptom questionnaires]. Tijdschrift voor Gezondheidswetenschappen 1998, 76:435-441.

7. Terluin B: Naar een nieuwe indeling van psychosociale problemen in de eerste lijn. Een secundaire analyse van de symptomatologie van 396 huisartspatiënten en 67 cliënten van het algemeen maatschappelijk werk [To a new classification of common mental disorders in primary care. A secondary analysis of the symptoms of 396 general practice patients and 67 social work clients]. Huisarts Wet 1998, 41:219-228,245.

8. Reliability, precision and smallest detectable change. Additional file to reference 1

9. Responsiveness. Additional file to reference 1

10. Respondent burden. Additional file to reference 1

11. Terluin B, Rijmen F, van Marwijk HWJ, Stalman WAB. Waarde van de Vierdimensionale Klachtenlijst (4DKL) voor het detecteren van depressieve stoornissen. Huisarts Wet 2007; 50: 300-5