title: Utilizing a Personal Smartphone Custom App to Assess the Patient Health Questionnaire-9 (PHQ-9) Depressive Symptoms in Patients With Major Depressive Disorder.
abstract: 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.
authors.affiliation: Harvard Longwood Psychiatry Residency Training Prorgam Boston, MA United States ; Beth Israel Deaconess Medical Center Department of Psychiatry Harvard Medical School Boston, MA United States.
authors.forename: John
authors.identifier: 0000-0002-5362-7937
authors.initials: J
authors.lastname: Torous
authors.affiliation: Department of Biostatistics Harvard School of Public Health Harvard University Boston, MA United States.
authors.forename: Patrick
authors.identifier: 0000-0001-6215-7343
authors.initials: P
authors.lastname: Staples
authors.affiliation: Beth Israel Deaconess Medical Center Department of Psychiatry Harvard Medical School Boston, MA United States.
authors.forename: Meghan
authors.identifier: 0000-0003-2986-3937
authors.initials: M
authors.lastname: Shanahan
authors.affiliation: Pocket Gems Palo Alto, CA United States.
authors.forename: Charlie
authors.identifier: 0000-0002-7698-4734
authors.initials: C
authors.lastname: Lin
authors.affiliation: Beth Israel Deaconess Medical Center Department of Psychiatry Harvard Medical School Boston, MA United States.
authors.forename: Pamela
authors.identifier: 0000-0002-3228-8569
authors.initials: P
authors.lastname: Peck
authors.affiliation: Beth Israel Deaconess Medical Center Department of Psychiatry Harvard Medical School Boston, MA United States.
authors.forename: Matcheri
authors.identifier: 0000-0002-5945-888X
authors.initials: M
authors.lastname: Keshavan
authors.affiliation: Department of Biostatistics Harvard School of Public Health Harvard University Boston, MA United States.
authors.forename: Jukka-Pekka
authors.identifier: 0000-0001-6613-8668
authors.initials: JP
authors.lastname: Onnela
keywords: depression; medical informatics; mobile health