Emotional State Questionnaire (EST-Q)

Abstract

The Emotional State Questionnaire (EST-Q) is a comprehensive self-report questionnaire designed to assess various dimensions of emotional distress, primarily focusing on symptoms related to Depression and Anxiety. Developed and validated by Aluoja et al. in 1999, the instrument is structured around five distinct subscales: Depression, Agoraphobia–Panic, Anxiety, Fatigue, and Insomnia. It utilizes a 5-point Likert scale response format, making it suitable for clinical screening and research contexts requiring reliable measurement of emotional states.

The EST-Q provides a multidimensional profile of affective symptoms, with strong overall internal consistency (Cronbach’s alpha = 0.88), making it a valuable tool for measuring the severity and co-occurrence of common mental health symptoms.

Keywords

Emotional State Questionnaire, EST-Q, Depression, Anxiety, Agoraphobia, Panic Disorder, Fatigue, Insomnia, Psychometric scale, Self-report.

Authors

Aluoja A, Shlik J, Vasar V, Luuk K, Leinsalu M.

Purpose

The primary purpose of the EST-Q is the rapid and reliable quantification of emotional symptoms, particularly those associated with common mental disorders such as major depressive disorder and various anxiety spectrum conditions. It is intended to serve as a screening and assessment tool to measure the severity and frequency of emotional distress across several critical domains.

By encompassing five key symptom clusters—Depression, Agoraphobia–Panic, Anxiety, Fatigue, and Insomnia—the EST-Q offers a holistic assessment. This structure enables clinicians and researchers to assess co-occurring symptoms, such as somatic complaints and sleep disturbances, which are frequently comorbid with core mood and anxiety conditions.

Construct

The EST-Q measures the psychological construct of general emotional distress as manifested through five core symptom clusters that align closely with standard diagnostic criteria for affective disorders.

The five measured sub-constructs are: Depression (sadness, anhedonia, worthlessness, suicidality); Anxiety (worry, tension, restlessness); Agoraphobia–Panic (sudden panic attacks, fear of public places or travel); Fatigue (loss of energy, feeling slowed down, lack of restorative rest); and Insomnia (difficulty initiating or maintaining sleep, or waking too early).

Validity

The structure of the items and subscales suggests strong face and content validity, as the items directly reflect common clinical symptoms of depression and anxiety as defined by standard diagnostic manuals. The development process focused on ensuring the questionnaire covered the breadth of symptoms associated with these emotional states.

The establishment of clear, empirically supported subscales (Depression, Anxiety, Agoraphobia–Panic, Fatigue, Insomnia) through factor analytic methods provides evidence of the scale’s construct validity, indicating that the instrument successfully differentiates between these related but distinct symptomatic domains of emotional distress.

Reliability

The EST-Q demonstrates high overall internal consistency, confirming its reliability across the total scale and most subscales. Internal consistency was measured using Cronbach’s alpha coefficients, which are reported as follows:

• Total EST-Q: 0.88
• Depression Subscale: 0.87
• Agoraphobia–Panic Subscale: 0.82
• Fatigue Subscale: 0.77
• Insomnia Subscale: 0.76
• Anxiety Subscale: 0.69

The alpha coefficients for the total scale and the Depression and Agoraphobia–Panic subscales are robust, indicating that the items within these clusters reliably measure their intended latent constructs. The Anxiety subscale shows a slightly lower, though generally acceptable, coefficient of 0.69.

Factor Analysis

The EST-Q is structured based on empirical findings that support a multi-factor model of emotional distress. The underlying factor analysis resulted in five distinct, though correlated, factors that isolate core dimensions of emotional disturbance commonly observed in clinical populations.

The five factors identified are Depression, Anxiety, Agoraphobia–Panic, Fatigue, and Insomnia. This solution highlights that while these symptoms frequently co-occur in patients, they are statistically separable constructs within the psychometric framework of the questionnaire, allowing for differentiated scoring.

Instrument

Test Type: Self-report screening tool for emotional distress and affective symptoms.

Format: 33-item questionnaire utilizing a 5-point Likert scale where respondents rate the frequency of symptoms based on the following anchors: 0—not at all; 1—seldom; 2—sometimes; 3—often; and 4—all the time.

Language Available: English (Original research published in the Nordic Journal of Psychiatry).

Population Group: Clinical and general adult populations.

Age Group: Adults (18 years and older).

Population Details: Developed and validated using samples relevant to the study of psychological disorders, focusing on individuals experiencing symptoms of depression and anxiety.

Test Methodology: The instrument is administered as a paper-and-pencil or digital survey. Respondents rate each item independently based on a specified recall period, typically ranging from the past week to the past month.

Keywords

EST-Q, Affective disorders, Symptom screening, Mental health assessment, Psychometrics, Internal consistency.

Authors

Author ORCID Identifier: Not specified in the source material.

Affiliation Email addresses: Not specified in the source material.

Correspondence Address: Not specified in the source material.

Permissions & Fee and Test Year

The EST-Q was first published in 1999. Information regarding specific permissions, licensing requirements, and associated fees is not detailed in the original source material. However, the instrument’s availability via a publicly linked PDF suggests it is often used for non-commercial research purposes, provided the original authors (Aluoja et al., 1999) are appropriately cited.

The original PDF of the instrument and related information can be downloaded here: http://www.mentalhealthpromotion.net/resources/aluoja-et-al-1999.pdf

Reference’s

Aluoja A, Shlik J, Vasar V, Luuk K, Leinsalu M. Development and psychometric properties of the Emotional State Questionnaire, a self-report questionnaire for depression and anxiety. Nord J Psychiatry 1999; 53:443–449.

Items of the Emotional State Questionnaire (EST-Q)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. Feelings of sadness
2. Feeling easily irritated or annoyed
3. Feeling no interest or pleasure in things
4. Fatigue or loss of energy
5. Feelings of worthlessness
6. Self-accusations
7. Recurrent thoughts of death or suicide
8. Diminished ability to think or concentrate
9. Feeling slowed down
10. Difficulty falling asleep
11. Restless or disturbed sleep
12. Waking up too early
13. Excessive sleepiness
14. Loss of appetite
15. Excessive appetite
16. Feeling lonely
17. Hopelessness about the future
18. Impossible to enjoy things
19. Rest does not restore strength
20. Feeling anxious or fearful
21. Being easily fatigued
22. Tension or inability to relax
23. Excessive worry about several different things
24. Feeling so restless that it is hard to sit still
25. Sudden attacks of panic with palpitations, shortness of breath, faintness, or other frightening bodily sensations
26. Easily startled
27. Fear of being outside home alone
28. Feeling afraid in streets or open places
29. Fear of fainting in public
30. Feeling afraid of travelling by bus, train, or car
31. Fear of ha‎ving a serious illness that has been not diagnosed by the doctors

Subscale Item Groupings:

• Depression (items: 1, 3, 5, 6, 7, 16, 17, and 18)
• Agoraphobia–Panic (items: 25, 29, 30, 31, and 32)
• Anxiety (items: 2, 20, 22, 23, 24, and 26)
• Fatigue (items: 4, 5, 9, 19, and 21)
• Insomnia (items: 10, 11, and 12)