Emotional State Questionnaire (EST-Q)

Abstract

The Emotional State Questionnaire (EST-Q) is a concise, 31-item self-report scale developed in 1999 by Aluoja, Shlik, Vasar, Luuk, and Leinsalu. It was specifically designed to assess common psychological distress symptoms, with a primary focus on dimensions related to depression and anxiety. The instrument measures five distinct, yet often comorbid, subscales: Depression, Anxiety, Agoraphobia–Panic, Fatigue, and Insomnia. The EST-Q is a valuable tool for rapid screening and research in both clinical and community settings, demonstrating strong psychometric properties across its composite dimensions.

Keywords

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

Authors

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

Purpose

The primary purpose of the Emotional State Questionnaire (EST-Q) is to provide a quick and reliable measure of various emotional and somatic symptoms associated with common mental health disorders, specifically those within the depression and anxiety spectrums. It functions as a self-report screening tool intended for use in epidemiological studies, primary care settings, and general population surveys to identify individuals experiencing significant psychological distress.

By encompassing five distinct subscales, the EST-Q allows researchers and clinicians to obtain a differential diagnosis of symptom clusters, moving beyond a single global distress score to identify specific areas of concern such as sleep disturbance or agoraphobic tendencies.

Construct

The EST-Q measures a multidimensional construct of psychological distress, encompassing a range of emotional, cognitive, and somatic symptoms. The scale is structured to capture five distinct, yet often comorbid, clinical domains derived from established diagnostic criteria for mood and anxiety disorders:

• Depression: Measures symptoms such as sadness, loss of pleasure, worthlessness, and suicidal ideation.
• Anxiety: Assesses generalized feelings of tension, worry, irritability, and restlessness.
• Agoraphobia–Panic: Focuses on sudden attacks of panic, fear of public places, and specific situational fears (e.g., travel).
• Fatigue: Measures lack of energy, easy fatigability, and physical exhaustion not relieved by rest.
• Insomnia: Evaluates various sleep disturbances, including difficulty falling asleep, disturbed sleep, and early waking.

Validity

The development of the Emotional State Questionnaire (EST-Q) involved establishing robust psychometric properties through the foundational study published in the *Nordic Journal of Psychiatry*. The scale’s construct validity is supported by the clear factor structure, which successfully separated symptoms into the five hypothesized clinical domains (Depression, Anxiety, Agoraphobia–Panic, Fatigue, and Insomnia). This differentiation suggests that the items effectively measure their intended, distinct constructs.

While specific coefficients for convergent and discriminant validity were detailed in the original 1999 paper, the overall structure confirms that the EST-Q is valid for assessing the symptomatic severity of common emotional disorders in self-report format.

Reliability

The EST-Q demonstrates strong internal consistency, confirming its reliability across the total scale and its subscales, as measured by Cronbach’s Alpha coefficients derived from the development sample. High alpha values indicate that the items within the scale and its subscales consistently measure the same underlying construct.

The reliability coefficients reported for the EST-Q are 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

Factor Analysis

The factor analysis conducted during the scale’s development identified five primary factors, which correspond directly to the five clinical subscales used for scoring. This structure confirms that the symptoms cluster logically into well-established clinical domains.

The established subscales and their corresponding item assignments are:

• Depression: Items 1, 3, 5, 6, 7, 16, 17, and 18.
• Anxiety: Items 2, 20, 22, 23, 24, and 26.
• Agoraphobia–Panic: Items 25, 29, 30, 31, and 32 (Note: Item numbers 27 and 28 are omitted in the original listing, and the source item 32 is likely the intended item 32).
• Fatigue: Items 4, 5, 9, 19, and 21.
• Insomnia: Items 10, 11, and 12.

Instrument

Test Type: Self-report questionnaire

Format: 31 items (as listed in the source content) rated on a 5-point Likert scale (0=not at all; 1=seldom; 2=sometimes; 3=often; and 4=all the time).

Language Available: English (and originally developed in Estonian, though often used internationally in English translation).

Population Group: Adults

Age Group: Typically 18 years and older.

Population Details: Utilized primarily in general population surveys, primary care settings, and studies involving individuals at risk for or diagnosed with depression or anxiety disorders.

Test Methodology: Scores are calculated by summing the ratings for the total scale or for the respective subscales. Higher scores indicate greater frequency or severity of the measured symptom.

Keywords

Emotional distress, Self-assessment, Psychometric scale, Clinical screening, Mood disorders, Sleep disturbance, Agoraphobia.

Authors

Author ORCID Identifier: Not provided in source.

Affiliation Email addresses: Not provided in source.

Correspondence Address: Not provided in source.

Permissions & Fee and Test Year

The scale was developed and published in 1999. The instrument has been used widely in academic research. The original PDF describing the scale and its psychometric properties is available online for research use. The original PDF 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