Utilizing a Personal Smartphone Custom App to Assess the Patient Health Questionnaire-9 (PHQ-9) Depressive Symptoms in Patients With Major Depressive Disorder.

John Torous,Matcheri Keshavan,Patrick Staples,Pamela Peck,Meghan Shanahan,Charlie Lin,Jukka-Pekka Onnela

doi:10.2196/mental.3889

Abstract

BackgroundAccurate reporting of patient symptoms is critical for diagnosis and therapeutic monitoring in psychiatry. Smartphones offer an accessible, low-cost means to collect patient symptoms in real time and aid in care.ObjectiveTo investigate adherence among psychiatric outpatients diagnosed with major depressive disorder in utilizing their personal smartphones to run a custom app to monitor Patient Health Questionnaire-9 (PHQ-9) depression symptoms, as well as to examine the correlation of these scores to traditionally administered (paper-and-pencil) PHQ-9 scores.MethodsA total of 13 patients with major depressive disorder, referred by their clinicians, received standard outpatient treatment and, in addition, utilized their personal smartphones to run the study app to monitor their symptoms. Subjects downloaded and used the Mindful Moods app on their personal smartphone to complete up to three survey sessions per day, during which a randomized subset of PHQ-9 symptoms of major depressive disorder were assessed on a Likert scale. The study lasted 29 or 30 days without additional follow-up. Outcome measures included adherence, measured by the percentage of completed survey sessions, and estimates of daily PHQ-9 scores collected from the smartphone app, as well as from the traditionally administered PHQ-9.ResultsOverall adherence was 77.78% (903/1161) and varied with time of day. PHQ-9 estimates collected from the app strongly correlated (r=.84) with traditionally administered PHQ-9 scores, but app-collected scores were 3.02 (SD 2.25) points higher on average. More subjects reported suicidal ideation using the app than they did on the traditionally administered PHQ-9.ConclusionsPatients with major depressive disorder are able to utilize an app on their personal smartphones to self-assess their symptoms of major depressive disorder with high levels of adherence. These app-collected results correlate with the traditionally administered PHQ-9. Scores recorded from the app may potentially be more sensitive and better able to capture suicidality than the traditional PHQ-9.

Highlights

Depression is a highly prevalent illness, both in the United States and worldwide, with a tremendous psychiatric, medical, and economic burden [1].Recently, there has been increased appreciation of the dynamic nature of depression, with several studies suggesting the clinical importance of temporal fluctuations of symptoms, including suicidal ideation [2,3]
Subjects were recruited from the outpatient psychiatry clinics at Beth Israel Deaconess Medical Center and the Massachusetts Mental Health Center, both located in Boston, Massachusetts
The 13 subjects consisted of 3 males (23%) and 10 females (77%), with mean ages of 48 (SD 16) and 35 (SD 13), respectively

Summary

Introduction

Depression is a highly prevalent illness, both in the United States and worldwide, with a tremendous psychiatric, medical, and economic burden [1].Recently, there has been increased appreciation of the dynamic nature of depression, with several studies suggesting the clinical importance of temporal fluctuations of symptoms, including suicidal ideation [2,3]. The Patient Health Questionnaire-9 (PHQ-9) is a validated depression rating scale frequently utilized both in primary care [4] and psychiatry clinics It assesses symptoms of depression over the preceding 2 weeks and is used for screening, diagnosing, and monitoring [5]. Objective: To investigate adherence among psychiatric outpatients diagnosed with major depressive disorder in utilizing their personal smartphones to run a custom app to monitor Patient Health Questionnaire-9 (PHQ-9) depression symptoms, as well as to examine the correlation of these scores to traditionally administered (paper-and-pencil) PHQ-9 scores. Conclusions: Patients with major depressive disorder are able to utilize an app on their personal smartphones to self-assess their symptoms of major depressive disorder with high levels of adherence These app-collected results correlate with the traditionally administered PHQ-9. Scores recorded from the app may potentially be more sensitive and better able to capture suicidality than the traditional PHQ-9

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