The Patient Health Questionnaire (PHQ) is a widely used mental-health screening tool dating from the 1990s and mandated by agencies including the National Institutes of Health. A new paper in JAMA Psychiatry, led by Zachary Cohen of the University of Arizona, reports that a single instructional phrase in the PHQ—asking whether a person has been "bothered by" symptoms and then asking frequency—can produce inconsistent answers.
In the study, about 850 participants first completed a PHQ. They then read a hypothetical: imagine oversleeping nearly every day for a week but not being bothered by it, for example on vacation. Only 328 participants (38%) selected "not at all" for being bothered in that scenario. Moreover, only 146 participants (17%) said they would answer future PHQs according to how much they were bothered rather than simply how often symptoms occurred.
Cohen and colleagues note that this inconsistency can create misleading clinical or research data. For example, passive sleep data from smartwatches could conflict with PHQ responses, and intentional appetite reduction from GLP-1 drugs such as Ozempic could be misinterpreted as a depression symptom if the "bothered by" element is ignored. The paper proposes a clear next step: change PHQ wording to separate frequency from distress—either ask plainly how often a symptom happens or clearly emphasize whether the symptom "bothers" the person—and calls for further studies to test whether such wording improvements help assessment.
Additional coauthors are from the University of Manchester; the University of Iceland; the Ivo Pilar Institute of Social Sciences; KU Leuven; Yale University; and Leiden University. Source: University of Arizona.
Difficult words
- mandate — require officially by an authority or lawmandated
- screening — process to check people for a condition
- inconsistency — lack of agreement between answers or facts
- frequency — how often something happens in time
- misinterpret — understand or explain something incorrectlymisinterpreted
- misleading — giving a wrong or false impression
- assessment — process of judging or measuring something
Tip: hover, focus or tap highlighted words in the article to see quick definitions while you read or listen.
Discussion questions
- How might separating frequency from whether a symptom bothers someone change clinical assessments? Give reasons.
- What are the benefits and limits of using passive data from devices (for example, smartwatches) alongside questionnaires?
- How should researchers handle effects of medications (like appetite-reducing drugs) when interpreting questionnaire responses?
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