A study led by researchers at Tucson-based University of Arizona found that 62% of participants did not interpret a widely used mental health screening tool consistently, raising concerns about the reliability of data it produces.
The study was published Dec. 17 in JAMA Psychiatry. Researchers recruited 849 adults to complete the Patient Health Questionnaire. Afterward, participants were presented with a hypothetical scenario involving a symptom — such as oversleeping daily while on vacation — and asked how they would respond on the PHQ: based on frequency or whether the symptom bothered them.
Participants then reflected on how they had interpreted the original questionnaire and how they would answer in the future. The study measured discrepancies between literal interpretation of the intrusion and actual response behavior.
Here are five things to know:
- The PHQ, in use since the 1990s and mandated by agencies including the NIH, asks patients how often they have been “bothered by” various symptoms. Researchers found most respondents misinterpret this phrasing.
- When presented with a scenario such as oversleeping daily without distress, only 38% selected the “correct” response of “not at all.” Just 17% said they would answer based on being “bothered” by symptoms in the future.
- Lead study author Zachary Cohen, PhD, a assistant professor at the University of Arizona, said inconsistent interpretation of questions can result in misleading data, potentially affecting care plans and skewing research, particularly with symptom-tracking technologies such as wearables.
- Misreading items such as appetite reduction from users of GLP-1 drugs could misclassify medication side effects as depression symptoms. The study highlights how such misunderstanding can distort mental health assessments.
- Dr. Cohen recommended revising questionnaire language to clearly differentiate between symptom frequency and patient distress. Follow-up studies are needed to test whether such changes improve response accuracy, he said.
