{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:58:49Z","timestamp":1790636329058,"version":"4.1.0"},"reference-count":18,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:sec id=\"ab-ybr250020-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Versions of the Patient Health Questionnaire (PHQ) such as PHQ-2, PHQ-8, and PHQ-9, are among the leading assessment tools for depression in research and clinical practice. However, important questions remain about its validity, particularly whether responses reflect symptom frequency or the degree to which symptoms are bothersome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ybr250020-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate how participants respond to the PHQ, described as a severity measure by its developers, with instructions about being bothered by symptoms and response options focused on symptom frequency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ybr250020-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This study used data from a general population sample collected via Amazon Mechanical Turk (MTurk) and a clinical sample with medium to high depression from the Operationalizing Digital PhenoTyping in the Measurement of Anhedonia (OPTIMA) study. Data were collected between 2022 and 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ybr250020-7\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>After completing the PHQ-8, participants\u2019 interpretation of instructions was assessed via 3 questions: (1) how they would respond to the PHQ sleep item in a hypothetical scenario where they overslept nearly every day but were comfortable with oversleeping; (2) whether they had based their earlier PHQ responses on symptom frequency, being bothered by symptoms, or both; and (3) how they would answer the PHQ in the future, based on these same 3 options.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ybr250020-8\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study sample consisted of a general population sample collected via MTurk (n\u2009=\u2009503; mean [SD] age,\u200940.63 [13.62] years; 253 male, 245 female, 3 transgender, 2 other) and a clinical sample with medium to high depression from the OPTIMA study (n\u2009=\u2009349; mean [SD] age,\u200933.44 [12.23] years; 120 male, 216 female, 5 transgender, 8 other). In the hypothetical oversleeping scenario, only 54.7% (n\u2009=\u2009275; MTurk) and 15.5% (n\u2009=\u200953; OPTIMA) of participants interpreted the PHQ as instructed (ie, the frequency with which the problems bothered them). When asked how they had responded to the PHQ, only 21.3% (n\u2009=\u2009107; MTurk) and 11.7% (n\u2009=\u200940; OPTIMA) of participants interpreted the instructions as instructed and only 22.3% (n\u2009=\u2009112; MTurk) and 9.9% (n\u2009=\u200934; OPTIMA) reported they would do so in the future, indicating stability in their interpretation. The current study also found that the PHQ-8 validity varied depending on how participants interpret its instructions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ybr250020-9\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>This study identified widespread misinterpretation of the PHQ instructions across community and clinical samples, raising doubts about its validity for both research and clinical decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2025.3796","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T16:00:33Z","timestamp":1765987233000},"page":"399","source":"Crossref","is-referenced-by-count":14,"title":["Interpretation Issues With the Patient Health Questionnaire Instructions"],"prefix":"10.1001","volume":"83","author":[{"given":"Margarita","family":"Panayiotou","sequence":"first","affiliation":[{"name":"Manchester Institute of Education, University of Manchester, Manchester, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josip","family":"Razum","sequence":"additional","affiliation":[{"name":"Faculty of Psychology, University of Iceland, Reykjavik, Iceland"},{"name":"Ivo Pilar Institute of Social Sciences, Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gudrun","family":"Eisele","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, KU Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirley B.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Psychology, Yale University, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiko I.","family":"Fried","sequence":"additional","affiliation":[{"name":"Clinical Psychology, Leiden University, Leiden, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary D.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Psychology Department, University of Arizona, Tucson"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"9","key":"ybr250020r1","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure.","volume":"16","author":"Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"issue":"2","key":"ybr250020r2","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.jpsychores.2004.09.006","article-title":"Detecting and monitoring depression with a two-item questionnaire (PHQ-2).","volume":"58","author":"L\u00f6we","year":"2005","journal-title":"J Psychosom Res"},{"issue":"1-3","key":"ybr250020r3","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.jad.2008.06.026","article-title":"The PHQ-8 as a measure of current depression in the general population.","volume":"114","author":"Kroenke","year":"2009","journal-title":"J Affect Disord"},{"issue":"6","key":"ybr250020r5","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1038\/s44159-022-00050-2","article-title":"Revisiting the theoretical and methodological foundations of depression measurement.","volume":"1","author":"Fried","year":"2022","journal-title":"Nat Rev Psychol"},{"issue":"9","key":"ybr250020r6","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-015247","article-title":"Are there researcher allegiance effects in diagnostic validation studies of the PHQ-9? 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A historical review and psychometric evaluation of measurement invariance.","author":"Hlynsson","year":"2025","journal-title":"Psychiatr Q"},{"key":"ybr250020r11","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2025.1478534","article-title":"Investigating low intensity focused ultrasound pulsation in anhedonic depression-A randomized controlled trial.","volume":"19","author":"Rotstein","year":"2025","journal-title":"Front Hum Neurosci"},{"issue":"1","key":"ybr250020r12","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1038\/s41746-025-01493-6","article-title":"Comparing self reported and physiological sleep quality from consumer devices to depression and neurocognitive performance.","volume":"8","author":"Akre","year":"2025","journal-title":"NPJ Digit Med"},{"issue":"5","key":"ybr250020r14","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1016\/S0006-3223(02)01866-8","article-title":"The 16-item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression.","volume":"54","author":"Rush","year":"2003","journal-title":"Biol Psychiatry"},{"issue":"4","key":"ybr250020r15","doi-asserted-by":"publisher","first-page":"867","DOI":"10.1016\/j.jesp.2009.03.009","article-title":"Instructional manipulation checks: Detecting satisficing to increase statistical power.","volume":"45","author":"Oppenheimer","year":"2009","journal-title":"J Exp Soc Psychol"},{"issue":"13","key":"ybr250020r16","doi-asserted-by":"publisher","first-page":"6334","DOI":"10.1017\/S0033291722003671","article-title":"The association between persistent cognitive difficulties and depression and functional outcomes in people with major depressive disorder.","volume":"53","author":"Matcham","year":"2023","journal-title":"Psychol Med"},{"issue":"6","key":"ybr250020r17","doi-asserted-by":"publisher","first-page":"2016","DOI":"10.1177\/10731911221134599","article-title":"Measurement equality of frequency and severity item response options on depression and generalized anxiety scales.","volume":"30","author":"Niileksela","year":"2023","journal-title":"Assessment"},{"issue":"2","key":"ybr250020r18","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1097\/00006842-200203000-00008","article-title":"The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms.","volume":"64","author":"Kroenke","year":"2002","journal-title":"Psychosom Med"},{"key":"ybr250020r4","unstructured":"Wolpert M. Funders agree first common metrics for mental health science. Linked In page. 2020. Accessed January 7, 2025. https:\/\/www.linkedin.com\/pulse\/funders-agree-first-common-metrics-mental-health-science-wolpert\/"},{"key":"ybr250020r13","unstructured":"Haddox? D, Cohen? DE, Fried? EI, Cohen? DE. PHQ variants. Open Science Framework. 2025. 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