The Psychometric Characteristics of the Four-Dimensional Symptom Questionnaire among a clinical sample and a healthy sample
Hala Kamel Al Sharif *1, Moh'd A. Shoqeirat 2
*Correspondence: Hala Kamel Al Sharif, Clinical Psychologist, hala.k.alsharif@gmail.com.
Copyright
© 2026 Al Sharif and Shoqeirat. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 07 May 2026
Published: 01 June 2026
DOI: https://doi.org/10.5281/zenodo.20526825
Abstract
This study investigates the psychometric characteristics of the Four-Dimensional Symptom Questionnaire in clinical and healthy samples. Sample consisted of (401): healthy people (140), physically ill patients (141) and psychiatric patients (120). Three instruments were used: the Four-Dimensional Symptom Questionnaire (4DSQ) (Terluin et al., 2004), the Beck Depression Inventory (BDI-II) (Beck et al., 1996), and the Kessler Psychological Distress Scale (K10) (Kessler et al., 2003).
The results showed that the Four-Dimensional Symptom Questionnaire (4DSQ) has acceptable psychometric properties, namely acceptable validity (construct and discriminant) and acceptable reliability (consistency “0.954”).
The results also showed a positive correlation between the Four-Dimensional Symptom Questionnaire (4DSQ) and the Beck Depression Inventory (BDI-II) and the Kessler Psychological Distress Scale (K10).
Keywords: Psychometric Characteristics, Four-Dimensional Symptom Questionnaire (4DSQ), Beck Depression Inventory (BDI-II), Kessler Psychological Distress Scale (K10).
Introduction
Human beings are the fundamental building blocks of society and the essence of its development. A psychologically healthy individual is a source of progress, intellectual growth, and advancement for any nation. For individuals to fulfil their personal and social responsibilities effectively, they must have good mental health, which enables them to adapt to their environment and cope with life's challenges. In contrast, individuals suffering from psychological disorders who do not receive an accurate diagnosis and appropriate psychological treatment may lose the opportunity for recovery and rehabilitation, preventing them from becoming productive members of society. Furthermore, such disorders may negatively affect not only the individual but also their family and community.
Specialists have differed in how they define mental health. Some have adopted a negative definition, viewing mental health as merely the absence of illness and symptoms. Others have regarded mental health as the achievement of psychological balance, satisfaction, and emotional well-being. A third perspective has combined both definitions, conceptualising mental health as the absence of pathological symptoms alongside satisfaction, balance, and psychological comfort, as well as the ability to engage effectively in daily life and practical activities while maintaining equilibrium and realising one’s capabilities (Awad, 2015). There is no doubt that psychological well-being and safety are inseparable components of overall health.
The World Health Organisation (WHO) defines mental health as a state of well-being in which an individual recognises their abilities, copes with the normal stresses of life, works productively and effectively, and contributes positively to their community. Mental health is closely linked to physical health and includes factors such as life satisfaction, resilience, adaptation, social support, and psychological and cognitive flexibility (WHO, 2020).
The clinical concept of mental disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), denotes a syndrome characterised by clinically significant disturbances in cognition, emotional regulation, or behaviour that reflect dysfunction in the psychological, biological, or developmental processes underlying mental functioning. These disorders are associated with significant distress or impairment in social, occupational, or other important areas of functioning. However, culturally accepted responses to stressors or losses, as well as behaviours arising from political, religious, or sexual conflicts between individuals and their societies, are not considered mental disorders unless such responses result from dysfunction in thinking or emotional regulation (APA, 2013).
Okasha (2008) indicated that psychological disorders affect approximately 5–6% of individuals regardless of the level of urbanization or geographical location.
Abada (2017) reported that psychological disorders vary in type, severity, and impact on affected individuals. These disorders have been classified into categories to facilitate their study and the identification of their symptoms. Among the most widely used classification systems are the International Classification of Diseases, Eleventh Revision (ICD-11), adopted by the World Health Organization (WHO), and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), adopted by the American Psychiatric Association (APA).
Mental health problems are also highly prevalent among patients attending general medical and family practice clinics. Uestuen and Sartorius (1995) reported that approximately 24% of primary healthcare patients suffer from psychological disorders. The most common of these disorders appear to be depressive disorders, anxiety disorders, somatic symptom disorders, and alcohol use disorder (Ansseau et al., 2004; Roca et al., 2009).
The World Health Organization (WHO, 2019) further noted that healthcare systems have not responded adequately to the burden of mental disorders. Consequently, a substantial gap exists worldwide between the need for treatment and its availability. Between 76% and 85% of individuals with mental disorders in low- and middle-income countries receive no treatment, while between 35% and 50% of affected individuals in high-income countries experience the same problem.
Statement of the Problem
Psychological disorders are often inadequately identified at the primary healthcare level by general practitioners and family physicians. Consequently, only a limited proportion of patients at this level are referred to specialised mental health services for further assessment and appropriate intervention.
The absence of assessment tools that assist primary healthcare providers in identifying psychological disorders among patients may be one factor contributing to the weak detection of mental disorders and the limited referral of patients to specialised psychological services.
A review of the theoretical literature and published research on mental health identified the Four-Dimensional Symptom Questionnaire (4DSQ) as an assessment instrument designed to help general practitioners and family physicians identify psychological disorders among patients attending primary healthcare clinics (Kleinstauber et al., 2021).
However, further examination of this questionnaire indicated that its psychometric properties have not yet been validated in the Jordanian context. Therefore, the instrument is not currently available for standardised use in primary healthcare settings in Jordan. Accordingly, the present study was conducted to investigate the psychometric characteristics of the Four-Dimensional Symptom Questionnaire and to adapt it for use in the Jordanian context.
Within the Arab context, only two related studies were identified. The first aimed to assess the psychological impact of the COVID-19 pandemic on Saudi society and to evaluate the performance of the Arabic version of the Four-Dimensional Symptom Questionnaire (Aljemaiah et al., 2021). This Arabic version was based on the translation developed by Elmessiri et al. (2016). The second study focused on translating the English version of the questionnaire into Arabic using the Egyptian dialect, without extensively examining the psychometric properties of the translated version.
The questionnaire was originally developed in Dutch and later translated into several languages, including English, Polish, French, German, and Turkish. Findings from these translations indicated that the psychometric properties were nearly identical to those of the original Dutch version (Chambe et al., 2015; Czachowski et al., 2012; Exner et al., 2018; Terluin, Smits et al., 2016).
The Four-Dimensional Symptom Questionnaire (4DSQ) consists of 50 self-report items distributed across four subscales that assist general practitioners and family physicians in differentiating between psychological distress and mental disorders:
Distress: Measures psychological distress symptoms.
Depression: Measures depressive thinking patterns, suicidal ideation, and symptoms of reduced pleasure.
Anxiety: Measures symptoms of various anxiety disorders, including generalised anxiety, panic attacks, specific anxiety, and avoidance behaviours.
Somatisation: Measures somatic symptom manifestations (Terluin et al., 2006).
Participants respond to the questionnaire items based on how they felt during the previous week, including the day of questionnaire administration.
Research Questions
The problem of the study can be summarised in the following main research question:
Objectives of the Study
The present study aims to investigate the psychometric properties of the Four-Dimensional Symptom Questionnaire (4DSQ) in clinical and healthy samples in Jordan. The following secondary objectives are derived from this main objective:
To identify evidence of validity for the Four-Dimensional Symptom Questionnaire (4DSQ) among a clinical sample and a healthy sample within the Jordanian environment.
To determine evidence of reliability for the Four-Dimensional Symptom Questionnaire (4DSQ) in clinical and healthy samples within the Jordanian context.
To examine the nature of the relationship between the Four-Dimensional Symptom Questionnaire, the Beck Depression Inventory-II (BDI-II), and the Kessler Psychological Distress Scale (K10).
Significance of the Study
The significance of the current study stems from the need to provide an assessment instrument with acceptable psychometric properties in both the Arab and Jordanian contexts. Such an instrument could assist general practitioners and family physicians in distinguishing between psychological distress and mental disorders experienced by patients. Consequently, this may facilitate the identification of mental disorders and the appropriate referral of patients to specialised healthcare services, ensuring that patients receive suitable interventions at the earliest possible stage and before symptoms worsen. The significance of this study can be discussed from two perspectives:
Theoretical Significance
Practical Significance
Study Terms and Operational Definitions
Psychometric properties refer to the availability of validity and reliability coefficients for a test within a specific environment (Barakat, 2012). They are statistical indicators that reflect the strength and quality of research instruments (e.g., scales, questionnaires, tests) and their items in achieving the intended objectives, including acceptable measures of validity and reliability (Bouqsara & Ziyad, 2015).
Operationally, psychometric properties are defined as indicators of validity and reliability derived from the Four-Dimensional Symptom Questionnaire in clinical and healthy samples in Jordan.
Validity refers to the extent to which an instrument accurately measures what it claims to measure and the degree to which it effectively assesses the characteristics for which it was designed. It represents the accuracy and precision with which an instrument measures the construct it was intended to assess (Carlson et al., 2007). Validity may also be defined as the degree to which an instrument measures the trait, attitude, or skill for which it was developed, as well as the appropriateness of using the instrument’s scores for making specific interpretations (Knile, 2000).
Operationally, the validity of the questionnaire is defined as concurrent validity, demonstrated by the correlation between the questionnaire scores and the scores on measures of psychological disorders indicating the presence of mental disorders.
Reliability is the extent to which results are unaffected by the procedures used to administer the questionnaire or by unrelated variables. It indicates the consistency of questionnaire results when administered repeatedly to the same individual under similar conditions and at different times. It is considered one of the essential characteristics of a sound assessment instrument and reflects the stability of the test over time (Carlson et al., 2007).
Operationally, the reliability of the questionnaire refers to its ability to yield consistent results when administered repeatedly under the same conditions. Reliability indicates the consistency of findings, meaning that the researcher obtains the same results when the measurement is repeated under identical circumstances. Reliability will be assessed using internal consistency via Cronbach’s alpha coefficient, as well as through the test–retest method with a ten-day interval between administrations.
The Four-Dimensional Symptom Questionnaire (4DSQ) is a tool designed to help general practitioners and family physicians distinguish between psychological distress and psychological disorders. It comprises 50 self-report items across four subdimensions: Distress, Depression, Anxiety, and Somatisation (Terluin et al., 2006).
Study Limitations
The study was limited to patients diagnosed with psychological disorders, excluding those with neurocognitive disorders such as Parkinson’s disease, Alzheimer’s disease, and dementia. Participants in this group were aged 20 years or older.
The study also included patients with chronic physical illnesses who were not diagnosed with psychological disorders, excluding those with cardiovascular disease. Participants in this group were aged 20 years or older.
Additionally, the study included healthy individuals who did not suffer from psychological disorders or physical illnesses and who were not taking any medications regularly.
Geographically, the sample was distributed across the Hashemite Kingdom of Jordan and included both males and females.
The implementation of the study extended from the second semester of the 2021/2022 academic year until the first semester of the 2022/2023 academic year.
The current study was limited to examining the psychometric properties of the Four-Dimensional Symptom Questionnaire (4DSQ) in clinical and healthy samples in the Jordanian context.
The study findings were also limited to the instruments used in the research, namely:
* Four-Dimensional Symptom Questionnaire (4DSQ)
* Beck Depression Inventory-II (BDI-II)
* Kessler Psychological Distress Scale (K10)
Theoretical Framework
Psychological Distress
Psychological distress is a defining characteristic of modern life, driven by the rapid pace of events, the increasing complexity of lifestyles, and the growing demands of everyday living. In the era of globalisation, people are exposed to the problems and crises of societies worldwide, as the world has effectively become a small village. Individuals continually encounter challenges and obstacles in their lives and often find themselves unable to cope with or adapt to these difficulties, resulting in feelings of helplessness and frustration, as well as internal conflict between their personal abilities and the stressful situations surrounding them (Al-Rashidi, 2019).
People experience varying levels of psychological stress when confronted with demands that require change and adaptation. Stress comprises two components: stressors, which require adjustment, and the stress response, which is the individual’s reaction to those stressors. Stressful life events may range from minor situations, such as traffic congestion, to severe experiences, such as wars or disease outbreaks (Almeida et al., 2011). Individuals’ responses to stress are influenced by their perceptions of stressful situations and by their perceived ability to cope effectively. Individuals who believe they possess sufficient abilities, resources, and competence to deal with stress tend to manage it more effectively and respond in healthier ways (Smith, 2011).
The term “stress” derives from the Latin word *Distringere*, meaning “to stretch tightly,” which later evolved in English into the term *distress*, meaning something unpleasant or undesirable. The term *stress* itself has been used to denote suffering and discomfort (Abdel Moati, 2004).
Psychological distress is a set of responses that reflect an individual’s discomfort in a particular situation. It is considered a biopsychosocial indicator that can be identified through behaviours exhibited by individuals in response to perceived threats in their environment (Abdel Rahim, 2016). Okasha (1992) described psychological distress as the challenge posed by unpleasant factors to an individual’s coping and adaptive capacities, whereas Al-Sahli (2010) defined it as the interaction between a person and their environment when that environment is perceived as stressful, exhausting, or exceeding available resources.
It is important to note that individuals’ reactions to stress and the fear it produces play a major role in the development of psychological disorders. Individuals exposed to moderately severe stressors over time are more likely to develop anxiety disorders, whereas those exposed to highly intense but temporary stressors are more likely to develop depressive disorders (Comer, 2014). Differences in individuals’ personalities and perceptions are always taken into account when evaluating sources of stress, since an event perceived as stressful by one individual may not necessarily be viewed in the same way by another (Al-Abdali, 2021).
Sources of psychological distress may generally be classified into several categories, including internal stressors originating within the individual, such as ambitions and goals; external stressors arising from the surrounding environment; and stress resulting from the interaction between the individual and their environment, such as pressures related to values, beliefs, and orientations that conflict with societal norms (Hussein, 2006).
Depression Disorders
Depression is the second most common psychological disorder associated with stressful life events, after anxiety, and it significantly affects both physical and psychological health. It is among the most common mental health problems prompting individuals to seek treatment and social and psychological support in healthcare settings. Together, depression and anxiety constitute the largest share of cases among visitors to psychiatric clinics and mental health institutions in contemporary societies (Layas, 2006).
The term “depression” encompasses sadness and grief (Sarhan, 2001). Depressive disorders encompass a broad range of symptoms, including mood disturbances, loneliness and apathy, and negative self-perception. Additional symptoms include profound sadness, feelings of worthlessness and insignificance, social withdrawal, and changes in sleep and appetite, alongside behavioural and emotional disturbances (Bushra, 2007).
Abdel Moati (2004) noted that Coles defined depression as a subjective experience characterised by sadness, pessimism, loss of interest, apathy, feelings of failure and dissatisfaction, tendencies towards self-harm, indecision, inability to make decisions, fatigue, appetite loss, guilt, self-contempt, slowed responses, and inability to exert effort.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a major depressive episode is a period lasting at least two weeks during which the individual experiences depressed mood most of the day, nearly every day. The mood is described as sad, hopeless, and demoralised. The diagnostic criteria comprise nine symptoms, of which at least five must be present. These symptoms include persistent depressed mood, loss of interest in daily activities, slowed thinking and psychomotor retardation observed by others, significant changes in appetite and weight, severe fatigue, feelings of guilt and worthlessness, diminished ability to think and concentrate, suicidal thoughts or attempts, and recurrent thoughts of death (APA, 2013).
Depression is among the most prevalent psychological disorders in industrialised countries. The World Health Organization (WHO, 2017) estimated that approximately 300 million people worldwide suffer from depression, representing 4.4% of the global population. Comer (2014) further reported that mood disorders affect approximately 9–13% of adults.
Within the framework of Sigmund Freud’s psychoanalytic theory, depression was interpreted as a condition arising from unconscious conflicts among the id, ego, and superego, together with the ego’s inability to control them. Consequently, feelings of anger and aggression become directed inward towards the self (Pettijohn, 1992).
Anxiety Disorders
Anxiety is considered a natural part of human life that influences behaviour. It is viewed as a sign of humanity, a reality of existence, a dynamic aspect of personality development, and a variable affecting human behaviour (Al-Momani & Naim, 2012). Anxiety is also regarded as an indicator of perceived threats to life or happiness and as a motivator for avoidance behaviours (Rateb, 2007).
Anxiety has occupied a prominent place in both historical and contemporary human thought. Research in this field has shown that since the beginning of the twentieth century, particularly during the early 1950s, more than 15,000 studies on anxiety had been conducted, using over 120 different methods to measure and assess its levels (Saad, 2004).
Freud defined anxiety as a severe, vague state of fear that dominates the individual, marked by a constant expectation of danger, leading to suspicion and pessimism about everything around them. By contrast, Aaron Beck described anxiety as an emotional state arising from the activation of fear, which can be viewed as a cognitive pattern reflecting the expectation of a highly probable threat (Faraj, 2009). Jung defined anxiety as a condition resulting from the dominance of fantasies or illusions perceived as threats to life, producing what he referred to as anxiety responses (Al-Zubaidi & Al-Harouti, 2017).
The section on anxiety disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) differentiates between normal fear and anxiety and pathological anxiety disorders.
The DSM-5 indicates that anxiety disorders are characterised by anxiety that exceeds normal adaptive responses and persists for six months or longer. It also notes that individuals with anxiety disorders typically overestimate the danger in situations they fear or avoid.
Somatic Disorders
Somatic disorders are among the most confusing phenomena encountered by professionals working in healthcare services. In cases of somatisation, physical symptoms appear in the absence of any clear medical explanation (Allen & Woolfolk, 2013).
Somatic disorders reflect the close relationship between the mind and body, as they involve physical symptoms that originate from psychological causes. Although psychological, social, and cultural factors contribute significantly to the development of somatisation, this does not diminish the importance of biological factors in its onset and progression (Al-Najjar, 2009).
Chronic and recurrent stressors are considered more dangerous in producing this type of disorder than temporary or short-term stressors. In addition, individuals’ physiological responses to stress depend on their perception of stressful situations and their personality characteristics, as different forms of stress produce different responses (Al-Zarrad, 2000). Psychological stress experienced by individuals may affect their cognitive, emotional, and personality functioning and may also lead to numerous somatic symptoms (Metwally, 2000).
Somatization is a condition in which physical symptoms manifest as expressions of psychological distress, prompting individuals to seek medical assistance for these physical complaints. Anxiety and depression are often considered the primary factors underlying the onset and exacerbation of such symptoms (Rief & Rojas, 2007; Simon & Gureje, 1999).
Somatization has also been described as physical complaints involving dysfunction in a part of the body or impairment of an organ's function, and as an expression of psychological distress. Physical treatment alone is often insufficient for complete recovery because the underlying psychological stressors remain unresolved without concurrent psychological intervention (Abu Al-Nile, 1994).
Somatic disorders are addressed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which describes them as persistent physical symptoms associated with excessive thoughts, feelings, and behaviours in the absence of clear and identifiable medical explanations. This diagnosis is assigned to individuals who exhibit an excessive focus on physical symptoms, such as pain, weakness, discomfort, and functional impairment, despite the absence of a sufficient medical explanation.
Most individuals with these disorders attend medical clinics, whereas relatively few seek psychiatric services. The DSM-5 classification includes seven categories of somatic disorders:
Previous Studies
This section reviews previous studies related to the topic of the current research, specifically those concerning the Four-Dimensional Symptom Questionnaire (4DSQ).
Kleinstäuber et al. (2021) examined the validity and reliability of the Four-Dimensional Symptom Questionnaire in a clinical mental health setting. The study sample comprised 159 patients attending outpatient psychological treatment clinics in both the United States and the Netherlands. Confirmatory factor analysis indicated that all subdimensions of the questionnaire were unidimensional. Reliability coefficients, calculated using Cronbach’s alpha, were high (≤0.90). The findings also showed a significant correlation between the Four-Dimensional Symptom Questionnaire (4DSQ) and the Outcome Questionnaire-45 (OQ-45), confirming that the 4DSQ demonstrates excellent validity and reliability indicators within mental health settings.
Aljemaiah et al. (2021) evaluated the psychological effects of the COVID-19 pandemic on Saudi society and assessed the performance of the Arabic version of the Four-Dimensional Symptom Questionnaire (4DSQ). The study sample comprised 347 participants who showed elevated levels of psychological distress, depression, anxiety, and somatisation compared with a healthy sample from Taif, Saudi Arabia. Cronbach’s alpha values were 0.93 for psychological distress, 0.88 for depression, 0.88 for anxiety, and 0.86 for somatisation. The results indicated elevated psychological distress among the Saudi population during the COVID-19 pandemic and confirmed that the Four-Dimensional Symptom Questionnaire demonstrated good validity and reliability.
Elmessiri et al. (2021) aimed to assess the suitability of the Arabic version of the Four-Dimensional Symptom Questionnaire for use among primary healthcare attendees in Egypt. The English version of the 4DSQ was translated into Arabic using the Egyptian colloquial dialect. The translation was reviewed by five translators, including a specialist psychiatrist, internists, and an English language specialist. Forward and backward translation procedures were then conducted by two bilingual physicians fluent in both Arabic and English. The study sample comprised 278 primary healthcare attendees in Egypt. Both the Arabic and English versions of the questionnaire, which included the dimensions of distress, depression, anxiety, and somatisation, were administered to participants. The results showed no statistically significant differences between the Arabic and English versions, indicating acceptable concurrent validity of the Four-Dimensional Symptom Questionnaire within the Egyptian context.
Terluin et al. (2020) examined the psychometric characteristics of the Four-Dimensional Symptom Questionnaire in its Danish and Dutch versions. The study sample comprised 1,363 participants, of whom 63% were female and 37% were male. The findings showed that the Danish version of the 4DSQ measured the same dimensions as the original Dutch questionnaire.
Exner et al. (2018) investigated the psychometric properties of the German version of the Four-Dimensional Symptom Questionnaire and its correspondence with the original Dutch version. The study also examined the prevalence of mental health problems among older adults with multiple chronic illnesses. The sample comprised 185 German and 185 Dutch participants. The findings indicated that the German version of the 4DSQ demonstrated acceptable concurrent validity relative to the original Dutch version and that the instrument was suitable for screening mental health problems in primary healthcare settings.
Terluin et al. (2016) investigated the validity and reliability of the Four-Dimensional Symptom Questionnaire in the general population in the Netherlands. The study sample comprised 5,273 males and females from the general population. Factor analysis indicated that the depression dimension was unidimensional, whereas the remaining dimensions were bidimensional. Reliability, assessed using Cronbach’s alpha, was 0.95. The findings further indicated that there were no differences in levels of psychological distress, depression, and anxiety attributable to gender, age, or educational level, supporting the discriminant validity of the questionnaire. However, somatization scores varied with age, while somatization levels remained stable across gender and educational levels.
Another study by Terluin et al. (2016) examined the extent to which the anxiety dimension of the Four-Dimensional Symptom Questionnaire could identify specific anxiety disorders among 969 primary healthcare attendees. Factor analysis indicated that anxiety was a unidimensional construct within the questionnaire. The anxiety dimension was effective in detecting panic disorder, agoraphobia, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder among patients with generalised anxiety disorder. Generalised anxiety and specific anxiety were identified to a lesser extent. The results also demonstrated that the anxiety dimension of the 4DSQ shared characteristics with anxiety disorders.
Chambea et al. (2015) sought to determine whether the French version of the Four-Dimensional Symptom Questionnaire measured the same constructs as efficiently as the original Dutch version. The study sample comprised 231 patients and 15 French general practitioners. The findings indicated that the French version of the 4DSQ demonstrated high validity and reliability and measured the same dimensions as the original Dutch questionnaire.
Commentary on Previous Studies
The previous studies reviewed aimed to investigate the psychometric properties of the Four-Dimensional Symptom Questionnaire (4DSQ) across different populations, variables, and languages. These studies also compared the results of the original Dutch version with those of the translated versions. Furthermore, prior research highlighted the importance of the Four-Dimensional Symptom Questionnaire in detecting psychological disorders and distinguishing them from psychological distress among primary healthcare attendees. The review of the literature also demonstrated the use of several additional psychological measures to examine the extent of the relationship between the Four-Dimensional Symptom Questionnaire and other assessment instruments, as well as the degree of similarity and agreement in findings.
The review additionally revealed the scarcity of Arabic studies related to the current topic and the complete absence of studies conducted within the Jordanian context concerning the Four-Dimensional Symptom Questionnaire.
What distinguishes the present study from previous research is its focus on the psychometric properties of the Four-Dimensional Symptom Questionnaire in the Jordanian context. The study also compares the questionnaire with assessment tools that have not previously been examined in relation to the 4DSQ, namely the Beck Depression Inventory-II (BDI-II) and the Kessler Psychological Distress Scale (K10).
Another distinguishing feature of the current study is that it included two samples: a healthy sample and a clinical sample, which was divided into two groups, namely individuals diagnosed with psychological disorders and individuals suffering from physical illnesses. In addition, the study employed a relatively large sample size.
Methodology
The study employed a descriptive correlational design to investigate the psychometric properties of the Four-Dimensional Symptom Questionnaire among a clinical sample and a healthy sample in Jordan.
Study Population
The study population comprised all adult members of Jordanian society, including healthy individuals, physically ill patients attending family med