Utilizing a Personal Smartphone Custom App to Assess the Patient Health Questionnaire-9 (PHQ-9) Depressive Symptoms in Patients With Major Depressive Disorder
Open accessAbstract
Background: Accurate 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. 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. Methods: A 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. Results: Overall 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. 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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In depression, mobile apps have tracked changes in patient-reported mood.
“In depression, mobile apps have tracked changes in patient-reported mood [27-29] and have been used as part of randomized controlled trials to evaluate treatment efficacy [30].”
From Wearable technology for high-frequency cognitive and mood assessment in major depressive disorder: longitudinal observational study (2019) · cites this paper as [28]
Several proof-of-concept studies have highlighted activity changes captured by smartphone sensors, and the usage patterns are associated with depressive symptoms in adult patients with MDD.
“Several proof-of-concept studies have highlighted activity changes captured by smartphone sensors, and the usage patterns are associated with depressive symptoms in adult patients with major depressive disorder (MDD) [4,5].”
The most frequent primary co-morbid diagnoses in the reviewed studies were depressive disorders and borderline personality disorder, but inclusion was typically based on a recent history of self-reported suicidal thoughts and behaviors.
“Most frequent primary co-morbid diagnoses were depressive disorders (83, 84, 86) and borderline personality disorder [BPD (58, 64, 82)]; however, inclusion was typically based on (recent) history of self-reported STBs to ensure sufficient number of observations of STBs during the assessment period.”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [83]
Pseudo-random sampling schedules were most frequently used (57%, n = 13), followed by fixed sampling (26%, n = 6), and combined fixed and pseudo-random sampling (13%, n = 3).
“(pseudo)random sampling schedules were most frequently used [57%, n = 13 (42, 47, 51, 58, 61, 65, 69, 71, 79, 83, 85, 86, 88)], followed by fixed sampling [26%, n = 6 (45, 66, 67, 72, 80, 82)], and protocols that combined both fixed and (pseudo)random sampling [13%, n = 3 (47, 56, 60)].”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [83]
Two reviewed studies used a turn-over system where a subset of questions was randomly presented at a certain time point to limit repetition.
“Two studies used a turn-over system where a subset of questions was randomly presented at a certain time point to limit repetition (83, 87).”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [83]
The correlation between depression scores (including a suicidal ideation item) derived from the traditionally administered PHQ-9 and EMA-administered PHQ-9 was r = 0.84.
“The correlation between depression scores (incl. a suicidal ideation item) derived from the traditionally administered Patient Health Questionnaire-9 [PHQ-9 (93)] and EMA administered PHQ-9 was r = 0.84 (83).”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [83]
More severe depressive symptoms were reported through EMA than with a traditional retrospective questionnaire, and EMA reports of suicidal ideation were notably higher than questionnaire scores for 69% of the participants.
“More severe depressive symptoms were reported through EMA than with a traditional retrospective questionnaire, and EMA reports of suicidal ideation were notably higher than questionnaire scores for 69% of the participants (83).”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [83]
Response rates were higher in the afternoons and on weekend days.
“Response rates were higher in the afternoons (83) and on weekend days (84).”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [83]
The decline in compliance over time was not replicated by all studies: one study reported no decrease over time, another reported fluctuation before stabilizing after about 2 weeks, and another reported increased compliance over time during a 1-week EMA study.
“However, this effect was not replicated by all: rather than declining in a linear manner, one study reported that compliance rates did not decrease over time (66), fluctuated before stabilizing after ~2 weeks (83), or that compliance increased over time during a 1-week EMA study (81).”
From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [83]
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- Authors
- Torous, J., Staples, P., Shanahan, M., Lin, C., Peck, P., Keshavan, M., & Onnela, J.-P.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- Harvard University (US)
- Corresponding author
- Torous, John
- ORCID
- Venue
- JMIR Mental Health
- Publisher
- JMIR Publications Inc.
- Published
- 2015-03-24
- Volume
- 2
- Issue
- 1
- Pages
- e8
- ISSN
- 2368-7959 (ISSN-L)
- PMC
- PMC4607379
- OpenAlex
- W2130042179
- Cited by
- 258
- References
- 28
- Citations by year
- 2026: 9 · 2025: 19 · 2024: 23 · 2023: 22 · 2022: 30 · 2021: 42 · 2020: 28 · 2019: 18 · 2018: 24 · 2017: 23 · 2016: 13 · 2015: 7
- FWCI
- 36.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Mental Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institutes of Health
- National Institute of Mental Health (DP2MH103909)
- National Institute of Environmental Health Sciences (T32ES007142)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- major depressive disorder, PHQ-9, mobile application, adherence, suicidal ideation, daily symptom monitoring, psychiatric outpatients, digital mental health
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