Patient Health Questionnaire PHQ-9

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Approval Status

  • Approval Status: Approved
  • Example Task Force: 7/11/2019
  • SDWG: 7/25/2019 (updated 3/9/2023)

C-CDA 2.1 Example:

  • Mental Status Section 2.16.840.1.113883.10.20.22.2.56:2015-08-01
  • Assessment Scale Observation 2.16.840.1.113883.10.20.22.4.69
  • Assessment Scale Supporting Observation 2.16.840.1.113883.10.20.22.4.86

Reference to full CDA sample

  • https://github.com/jddamore/HL7-Task-Force-Examples/blob/master/C-CDAR2.1/MENTALSTATUSinemptyC-CDA_2.1.xml (Passes SITE validator 5/16/2019)

Validation location

  • HL7 Schematron (Diameter Health hosted) January 2019

Comments:

  • This is an example of to include a PHQ-9 survey with total score and compoonent questions. While not all questions may be necessary in all uses, the total score has an impact on quality measures related to depression screening.

Custodian:

  • John D'Amore jdamore@diameterhealth.com (GitHub: jddamore)

Keywords:

  • PHQ-9, mental status, assessment scale

Permalink

 

Example: download example view on GitHub 

<section>
    <!-- Mental Status Section -->
    <!-- An assessment should be included in the section where it is appropriate in clinical context -->
    <!-- Other asssessments may go into other sections. Depression screening is clinically appropriate for Mental Status -->
    <templateId root="2.16.840.1.113883.10.20.22.2.56" extension="2015-08-01"/>
    <code code="10190-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"
        displayName="Mental status Narrative"/>
    <title>MENTAL STATUS</title>
    <text>
        <table>
            <thead>
                <tr>
                    <th>Date</th>
                    <th>Assessment</th>
                    <th>Value</th>
                    <th>Relevant Reference Range</th>
                    <th>Interpretation</th>
                </tr>
            </thead>
            <tbody>
                <!-- Note that sending the total score may be adequate for some use cases, although both total and detail responses shown below -->
                <!-- PHQ-9 Total Score -->
                <tr>
                    <td ID="assessment" colspan="5">PHQ-9 Questionnaire (panel)</td>
                </tr>
                <tr ID="assessmentTotal">
                    <td>06/22/2015</td>
                    <td>PHQ-9 Total Score</td>
                    <td>12</td>
                    <td ID="assessmentReferenceRange">0-4</td>
                    <td>High</td>
                </tr>
                <!-- PHQ-9 Component Questions -->
                <tr ID="assessment1">
                    <td>06/22/2015</td>
                    <td>PHQ-9 Question: Little interest or pleasure in doing things?</td>
                    <td>0 (Not at all)</td>
                    <td/>
                    <td/>
                </tr>
                <tr ID="assessment2">
                    <td>06/22/2015</td>
                    <td>PHQ-9 Question: Feeling down, depressed, or hopeless?</td>
                    <td>1 (Several days)</td>
                    <td/>
                    <td/>
                </tr>
                <tr ID="assessment3">
                    <td>06/22/2015</td>
                    <td>PHQ-9 Question: Trouble falling or staying asleep, or sleeping too
                        much?</td>
                    <td>2 (More than half the days)</td>
                    <td/>
                    <td/>
                </tr>
                <tr ID="assessment4">
                    <td>06/22/2015</td>
                    <td>PHQ-9 Question: Feeling tired or having little energy?</td>
                    <td>0 (Not at all)</td>
                    <td/>
                    <td/>
                </tr>
                <tr ID="assessment5">
                    <td>06/22/2015</td>
                    <td>PHQ-9 Question: Poor appetite or overeating?</td>
                    <td>1 (Several days)</td>
                    <td/>
                    <td/>
                </tr>
                <tr ID="assessment6">
                    <td>06/22/2015</td>
                    <td>PHQ-9 Question: Feeling bad about yourself-or that you are a failure or have
                        let yourself or your family down?</td>
                    <td>3 (Nearly Every Day)</td>
                    <td/>
                    <td/>
                </tr>
                <tr ID="assessment7">
                    <td>06/22/2015</td>
                    <td>PHQ-9 Question: Trouble concentrating on things, such as reading the
                        newspaper or watching television?</td>
                    <td>2 (More than half the days)</td>
                    <td/>
                    <td/>
                </tr>
                <tr ID="assessment8">
                    <td>06/22/2015</td>
                    <td>PHQ-9 Question: Moving or speaking so slowly that other people could have
                        noticed. Or the opposite-being so fidgety or restless that you have been
                        moving around a lot more than usual?</td>
                    <td>3 (Nearly Every Day)</td>
                    <td/>
                    <td/>
                </tr>
                <tr ID="assessment9">
                    <td>06/22/2015</td>
                    <td>PHQ-9 Question: Thoughts that you would be better off dead, or of hurting
                        yourself in some way?</td>
                    <td>0 (Not at all)</td>
                    <td/>
                    <td/>
                </tr>
                <tr ID="assessment10">
                    <td>06/22/2015</td>
                    <td>PHQ-9 How difficult have these problems made it for you to do your work,
                        take care of things at home, or get along with other people?</td>
                    <td>(Not difficult at all)</td>
                    <td/>
                    <td/>
                </tr>
            </tbody>
        </table>
    </text>
    <entry typeCode="DRIV">
        <observation classCode="OBS" moodCode="EVN">
            <!-- Assessment Scale Observation -->
            <templateId root="2.16.840.1.113883.10.20.22.4.69"/>
            <id root="f1aa44dd-6f39-4f5c-b267-897c3824b673"/>
            <code code="44249-1" displayName="PHQ-9 quick depression assessment panel"
                codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
            <text>
                <reference value="#assessment"/>
            </text>
            <statusCode code="completed"/>
            <effectiveTime value="20150622"/>
            <!-- Note that the value attribute is required in an assessment scale observation. Since LOINC organizes this information -->
            <!-- where the total score is part of the panel, that total score code is shown through entryRelationship to supporting observation -->
            <!-- The total score, however, is the most relevant value of the panel, so it has also been elevated to the panel value -->
            <!-- INT is preferred for assessments such as a questionnaire. Units are not allowed for xsi:type="INT" -->
            <value xsi:type="INT" value="12"/>
            <interpretationCode code="H" codeSystem="2.16.840.1.113883.5.83" displayName="High" />
            <entryRelationship typeCode="COMP">
                <observation classCode="OBS" moodCode="EVN">
                    <!-- Assessment Scale Supporting Observation -->
                    <templateId root="2.16.840.1.113883.10.20.22.4.86"/>
                    <id root="a6a704ab-271a-4bfa-9f0d-1581da2b1235"/>
                    <code code="44261-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
                    <text>
                        <reference value="#assessmentTotal"/>
                    </text>
                    <statusCode code="completed"/>
                    <effectiveTime value="20150622"/>
                    <!-- Definition of "PQ" A dimensioned quantity expressing the result of a measurement act.-->
                    <!-- Definition of "INT" Integer numbers (-1,0,1,2, 100, 3398129, etc.) are precise numbers that are results of counting and enumerating..-->
                    <!-- INT is preferred for assessments such as a questionnaire. Units are not allowed for xsi:type="INT" -->
                    <value xsi:type="INT" value="12"/>
                </observation>
            </entryRelationship>
            <!-- The total score may be adequate for some use cases, although detail components can be sent as shown below as warranted by use case -->
            <entryRelationship typeCode="COMP">
                <observation classCode="OBS" moodCode="EVN">
                    <templateId root="2.16.840.1.113883.10.20.22.4.86"/>
                    <id root="a6a704ab-271a-4bfa-9f0d-1581da2b1186"/>
                    <code code="44250-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
                    <text>
                        <reference value="#assessment1"/>
                    </text>
                    <statusCode code="completed"/>
                    <effectiveTime value="20150622"/>
                    <value xsi:type="INT" value="0"/>
                    <!-- Systems may send a second value with LOINC answer concept  -->
                    <!-- xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list -->
                    <value xsi:type="CO" code="LA6568-5" displayName="Not at all"
                        codeSystem="2.16.840.1.113883.6.1"/>
                </observation>
            </entryRelationship>
            <entryRelationship typeCode="COMP">
                <observation classCode="OBS" moodCode="EVN">
                    <templateId root="2.16.840.1.113883.10.20.22.4.86"/>
                    <id root="466f43c8-fc2b-4161-b9a1-2d88688e5f74"/>
                    <code code="44255-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
                    <text>
                        <reference value="#assessment2"/>
                    </text>
                    <statusCode code="completed"/>
                    <effectiveTime value="20150622"/>
                    <value xsi:type="INT" value="1"/>
                    <!-- Systems may send a second value with LOINC answer concept  -->
                    <!-- xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list -->
                    <value xsi:type="CO" code="LA6569-3" displayName="Several days"
                        codeSystem="2.16.840.1.113883.6.1"/>
                </observation>
            </entryRelationship>
            <entryRelationship typeCode="COMP">
                <observation classCode="OBS" moodCode="EVN">
                    <templateId root="2.16.840.1.113883.10.20.22.4.86"/>
                    <id root="e3e5b3d7-76f5-48f1-8ba0-b2b4e6314f95"/>
                    <code code="44259-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
                    <text>
                        <reference value="#assessment3"/>
                    </text>
                    <statusCode code="completed"/>
                    <effectiveTime value="20150622"/>
                    <value xsi:type="INT" value="2"/>
                    <!-- Systems may send a second value with LOINC answer concept  -->
                    <!-- xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list -->
                    <value xsi:type="CO" code="LA6570-1" displayName="More than half the days"
                        codeSystem="2.16.840.1.113883.6.1"/>
                </observation>
            </entryRelationship>
            <entryRelationship typeCode="COMP">
                <observation classCode="OBS" moodCode="EVN">
                    <templateId root="2.16.840.1.113883.10.20.22.4.86"/>
                    <id root="4d77eb67-6588-4f77-b506-1d987eee1711"/>
                    <code code="44254-1" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
                    <text>
                        <reference value="#assessment4"/>
                    </text>
                    <statusCode code="completed"/>
                    <effectiveTime value="20150622"/>
                    <value xsi:type="INT" value="0"/>
                    <!-- Systems may send a second value with LOINC answer concept  -->
                    <!-- xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list -->
                    <value xsi:type="CO" code="LA6568-5" displayName="Not at all"
                        codeSystem="2.16.840.1.113883.6.1"/>
                </observation>
            </entryRelationship>
            <entryRelationship typeCode="COMP">
                <observation classCode="OBS" moodCode="EVN">
                    <templateId root="2.16.840.1.113883.10.20.22.4.86"/>
                    <id root="b24d5a2c-48d6-46a0-bd92-1c901e577cc3"/>
                    <code code="44251-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
                    <text>
                        <reference value="#assessment5"/>
                    </text>
                    <statusCode code="completed"/>
                    <effectiveTime value="20150622"/>
                    <value xsi:type="INT" value="1"/>
                    <!-- Systems may send a second value with LOINC answer concept  -->
                    <!-- xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list -->
                    <value xsi:type="CO" code="LA6569-3" displayName="Several days"
                        codeSystem="2.16.840.1.113883.6.1"/>
                </observation>
            </entryRelationship>
            <entryRelationship typeCode="COMP">
                <observation classCode="OBS" moodCode="EVN">
                    <templateId root="2.16.840.1.113883.10.20.22.4.86"/>
                    <id root="c67c51ea-4928-449d-b6c0-0f85b1975e07"/>
                    <code code="44258-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
                    <text>
                        <reference value="#assessment6"/>
                    </text>
                    <statusCode code="completed"/>
                    <effectiveTime value="20150622"/>
                    <value xsi:type="INT" value="3"/>
                    <!-- Systems may send a second value with LOINC answer concept  -->
                    <!-- xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list -->
                    <value xsi:type="CO" code="LA6571-9" displayName="Nearly every day"
                        codeSystem="2.16.840.1.113883.6.1"/>
                </observation>
            </entryRelationship>
            <entryRelationship typeCode="COMP">
                <observation classCode="OBS" moodCode="EVN">
                    <templateId root="2.16.840.1.113883.10.20.22.4.86"/>
                    <id root="68301d32-9158-429b-92b6-1f1e553a2f8c"/>
                    <code code="44252-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
                    <text>
                        <reference value="#assessment7"/>
                    </text>
                    <statusCode code="completed"/>
                    <effectiveTime value="20150622"/>
                    <value xsi:type="INT" value="2"/>
                    <!-- Systems may send a second value with LOINC answer concept  -->
                    <!-- xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list -->
                    <value xsi:type="CO" code="LA6570-1" displayName="More than half the days"
                        codeSystem="2.16.840.1.113883.6.1"/>
                </observation>
            </entryRelationship>
            <entryRelationship typeCode="COMP">
                <observation classCode="OBS" moodCode="EVN">
                    <templateId root="2.16.840.1.113883.10.20.22.4.86"/>
                    <id root="400a66ad-3d5f-4b6e-913e-81e46241d83b"/>
                    <code code="44253-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
                    <text>
                        <reference value="#assessment8"/>
                    </text>
                    <statusCode code="completed"/>
                    <effectiveTime value="20150622"/>
                    <value xsi:type="INT" value="3"/>
                    <!-- Systems may send a second value with LOINC answer concept  -->
                    <!-- xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list -->
                    <value xsi:type="CO" code="LA6571-9" displayName="Nearly every day"
                        codeSystem="2.16.840.1.113883.6.1"/>
                </observation>
            </entryRelationship>
            <entryRelationship typeCode="COMP">
                <observation classCode="OBS" moodCode="EVN">
                    <templateId root="2.16.840.1.113883.10.20.22.4.86"/>
                    <id root="36792a59-7905-406e-a920-701a2ae746be"/>
                    <code code="44260-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
                    <text>
                        <reference value="#assessment9"/>
                    </text>
                    <statusCode code="completed"/>
                    <effectiveTime value="20150622"/>
                    <value xsi:type="INT" value="0"/>
                    <!-- Systems may send a second value with LOINC answer concept  -->
                    <!-- xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list -->
                    <value xsi:type="CO" code="LA6568-5" displayName="Not at all"
                        codeSystem="2.16.840.1.113883.6.1"/>
                </observation>
            </entryRelationship>
            <!-- New question for PHQ9 (question 10) not included in score -->
            <entryRelationship typeCode="COMP">
                <observation classCode="OBS" moodCode="EVN">
                    <templateId root="2.16.840.1.113883.10.20.22.4.86"/>
                    <id root="aa81195f-3cd4-4b55-b79b-1eb71bc42c9e"/>
                    <code code="69722-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
                    <text>
                        <reference value="#assessment10"/>
                    </text>
                    <statusCode code="completed"/>
                    <effectiveTime value="20150622"/>
                    <!-- xsi:type could be CD or CO - CO Indicates to receiver that these values can be put in an ordered list -->
                    <value xsi:type="CO" code="LA6572-7" displayName="Not difficult at all"
                        codeSystem="2.16.840.1.113883.6.1"/>
                </observation>
            </entryRelationship>
            <referenceRange>
                <observationRange>
                    <text>
                        <reference value="#assessmentReferenceRange"/>
                    </text>
                    <value xsi:type="IVL_INT">
                        <low value="0"/>
                        <high value="4"/>
                    </value>
                    <!-- This interpretation code denotes that this reference range is for normal results. This is not the interpretation a specific patient value-->
                    <interpretationCode code="N" codeSystem="2.16.840.1.113883.5.83" displayName="Normal" />
                </observationRange>
                <!-- Other ranges may be included as well (such as a high range) as considered appropriate per observation and use case -->
            </referenceRange>
        </observation>
    </entry>
</section>

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