The Patient Health Questionnaire-9 (PHQ-9) responses submitted overnight showed higher rates of depression severity and thoughts of self-harm or being better off dead, according to an Aug. 18 Epic Research report.
Researchers examined more than 600,000 PHQ-9 scores for U.S. patients aged 12 and older, submitted from Jan. 1, 2023, to April 30, 2026. They also assessed the volume of surveys, PHQ-9 total scores and rates of positive responses to question nine — which asks about thoughts of self-harm or being better off dead — by hour using descriptive statistics.
Most responses were during the day, specifically peak mid-morning, with only about 2.5% of submissions occurring between 11 p.m. and 5:59 a.m. At the 2 a.m. hour, about 14.1% of surveys scored in the moderately severe or severe range, compared with about 5.3% at the 6 a.m. hour. Positive responses to question nine were highest at the 2 a.m. hour at 10.1% and lowest at the 6 a.m. hour at 4.2%.
Despite higher overnight rates, nearly 97% of all positive responses to question nine and 96% of severe-range responses were submitted during the day.
The data came from Cosmos, which represents more than 322 million patient records from 2,200 hospitals and more than 50,000 clinics.
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