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    The associations with other questionnaires were assessed with Pearson correlations and regression analyses. The factorial structure of the 4DSQ was assessed through confirmatory factor analysis (CFA).The 4DSQ's special feature is its ability to distinguish general distress from depression, anxiety and somatization.The aim of this paper is to investigate the 4DSQ's validity.The English version was obtained through a procedure of translation into English and back-translation into Dutch.The English translation was adjusted to obtain the best equivalence with the original Dutch 4DSQ. The 4DSQ is grounded in our study of the clinical characteristics of patients with a "nervous breakdown" presenting in general practice. The purpose of this paper is to evaluate its criterion and construct validity.

    The items are worded as questions similar to those that can be asked in everyday primary care practice. For example, item 26 reads "During the past week, did you feel easily irritated? The 4DSQ does not contain any positive affect questions, nor any other "reversed" worded questions.

    The Distress scale contains 16 items and has a score range of 0-32, the Depression scale contains 6 items and has a range of 0-12, the Anxiety scale contains 12 items and has a range of 0-24, and the Somatization scale contains 16 items and has a range of 0-32 ( Table 1 ).

    The 4DSQ is free for non-commercial use in health care and research and it is available as a Dutch and an English version.

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    The Four-Dimensional Symptom Questionnaire (4DSQ) is a Dutch self-report questionnaire designed to assess common psychological symptoms in primary care patients.

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