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O3-5088: Add Automatic Calculation for PHQ-9 Total Score in Mental Health Assessment Form #44

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Merged
merged 5 commits into from
Oct 20, 2025
Merged

O3-5088: Add Automatic Calculation for PHQ-9 Total Score in Mental Health Assessment Form #44

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61131b9
Added calculateExpression for the Mental Health Assessment Form PHQ-…
VeronicaMuthee Oct 7, 2025
8414969
Revise Automatic Calculation for PHQ-9 Total Score in Mental Health A…
VeronicaMuthee Oct 20, 2025
b675736
Update Mental Health Assessment Form.json
VeronicaMuthee Oct 20, 2025
3db85a0
Update PHQ-9 form structure and question types
VeronicaMuthee Oct 20, 2025
6cde4cd
Add concept mappings for mental health assessment form
VeronicaMuthee Oct 20, 2025
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103 changes: 67 additions & 36 deletions configuration/backend_configuration/ampathforms/Mental Health Assessment Form.json
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Original file line number Diff line number Diff line change
Expand Up @@ -5,7 +5,7 @@
"retired": false,
"pages": [
{
"label": "PHQ-2",
"label": "PHQ-2 Screening",
"sections": [
{
"label": "Introduction",
Expand All @@ -18,7 +18,11 @@
},
"id": "fooMarkdown",
"value": [
"**This form is used :** for screening, diagnosing, monitoring and measuring the severity of depression."
"**PHQ-9 Depression Screening**",
"",
"This form is used for screening, diagnosing, monitoring and measuring the severity of depression.",
"",
"**Instructions:** Over the last 2 weeks, how often have you been bothered by any of the following problems?"
]
}
]
Expand All @@ -38,14 +42,6 @@
"type": "CIEL",
"value": "160753"
},
{
"type": "CIEL",
"value": "160753"
},
{
"type": "SNOMED-CT",
"value": "439771001"
},
{
"type": "SNOMED-CT",
"value": "439771001"
Expand Down Expand Up @@ -121,6 +117,16 @@
"questionOptions": {
"rendering": "radio",
"concept": "167007AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"conceptMappings": [
{
"type": "CIEL",
"value": "167007"
},
{
"type": "LOINC",
"value": "44255-8"
}
],
"answers": [
{
"concept": "160215AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
Expand All @@ -142,16 +148,6 @@
"label": "Nearly every day",
"conceptMappings": []
}
],
"conceptMappings": [
{
"type": "CIEL",
"value": "167007"
},
{
"type": "LOINC",
"value": "44255-8"
}
]
},
"behaviours": [
Expand All @@ -171,7 +167,7 @@
]
},
{
"label": "PHQ-9",
"label": "PHQ-9 Additional Questions",
"sections": [
{
"label": "Further evaluation",
Expand Down Expand Up @@ -331,7 +327,7 @@
"id": "phq9_5"
},
{
"label": "6. Feeling bad about yourself - or that you’re a failure or have let yourself or your family down",
"label": "6. Feeling bad about yourself - or that you're a failure or have let yourself or your family down",
"type": "obs",
"questionOptions": {
"rendering": "radio",
Expand Down Expand Up @@ -547,21 +543,53 @@
]
},
{
"label": "PHQ-9 score",
"label": "Scoring and Results",
"sections": [
{
"label": "Total scores",
"label": "PHQ-9 Scoring",
"isExpanded": "true",
"questions": [
{
"label": "PHQ-9 score obtained by adding score for each question",
"label": "PHQ-2 Score (Questions 1-2)",
"type": "obs",
"questionOptions": {
"rendering": "number",
"concept": "165137AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"max": "6",
"min": "0",
"calculate": {
"calculateExpression": "calcPHQ9Score(phq2_1, phq2_2)"
},
"conceptMappings": [
{
"type": "SNOMED-CT",
"value": "720433000"
},
{
"type": "CIEL",
"value": "165137"
}
]
},
"behaviours": [
{
"intent": "*",
"readonly": "true"
}
],
"id": "phq2Score"
},
{
"label": "PHQ-9 Total Score (Questions 1-9)",
"type": "obs",
"questionOptions": {
"rendering": "number",
"concept": "165137AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"max": "27",
"min": "0",
"showDate": "",
"calculate": {
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@denniskigen denniskigen Oct 7, 2025 •
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The inline calculateExpression here is quite long (~1000 chars) and repeats the UUID-to-score mapping 9 times. Could we consider factoring it out into a reusable custom expression helper function in the form engine instead?

We could add a calcPHQ9Score() helper to common-expression-helpers.ts (similar to calcBMI(), calcEDD(), etc) that looks like this:

/**
 * Calculates PHQ-9 (Patient Health Questionnaire-9) depression screening score
 * Supports both PHQ-2 (questions 1-2) and full PHQ-9 (questions 1-9)
 * Handles hidden/conditional questions by treating undefined/null values as 0
 * 
 * @param responses - Variable number of PHQ question responses (concept UUIDs)
 * @returns Total score (0-27 for full PHQ-9, 0-6 for PHQ-2 only)
 * 
 * @example
 * // PHQ-2 negative screen (questions 3-9 hidden)
 * calcPHQ9Score(phq2_1, phq2_2, phq9_3, phq9_4, phq9_5, phq9_6, phq9_7, phq9_8, phq9_9)
 * // Returns: 0 if both answered "Not at all"
 * 
 * @example
 * // Full PHQ-9
 * calcPHQ9Score(phq2_1, phq2_2, phq9_3, phq9_4, phq9_5, phq9_6, phq9_7, phq9_8, phq9_9)
 * // Returns: Sum of all 9 responses (0-27)
 */
calcPHQ9Score = (...responses: (string | null | undefined)[]): number => {
  const scoreMap: Record<string, number> = {
    '160215AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA': 0, // Not at all
    '167000AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA': 1, // Several days
    '167001AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA': 2, // More than half the days
    '167002AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA': 3, // Nearly every day
  };

  return responses.reduce((sum, answer) => {
    return sum + (answer ? (scoreMap[answer] ?? 0) : 0);
  }, 0);
};

And then we could simplify the calculateExpression in this form by leveraging the new expression helper as follows:

  "calculate": {
    "calculateExpression": "calcPHQ9Score(phq2_1, phq2_2, phq9_3, phq9_4, phq9_5, phq9_6, phq9_7, phq9_8, phq9_9)"
  }

Benefits of this approach:

  • Easier to read, test, and maintain
  • Centralizes the UUID mapping logic
  • Follows DRY principle
  • Matches the architectural pattern used elsewhere in the codebase

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@VeronicaMuthee VeronicaMuthee Oct 8, 2025

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@denniskigen thanks for your feedback, are you suggesting that the change (custom expression helper function) should be implemented in the form engine’s codebase, not directly in the form JSON? @samuelmale is this something you can assist us?

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@denniskigen denniskigen Oct 8, 2025 •
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Yes. And here's the PR openmrs/openmrs-esm-form-engine-lib#650

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@denniskigen denniskigen Oct 13, 2025

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New PR: openmrs/openmrs-esm-patient-chart#2787

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@denniskigen denniskigen Oct 14, 2025

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Update: PR merged. Should be available soon.

"calculateExpression": "calcPHQ9Score(phq2_1, phq2_2, phq9_3, phq9_4, phq9_5, phq9_6, phq9_7, phq9_8, phq9_9)"
},
"conceptMappings": [
{
"type": "SNOMED-CT",
Expand All @@ -573,7 +601,13 @@
}
]
},
"id": "phq9Score"
"behaviours": [
{
"intent": "*",
"readonly": "true"
}
],
"id": "phq9TotalScore"
}
]
}
Expand All @@ -583,21 +617,17 @@
"label": "Notes",
"sections": [
{
"label": "Notes",
"label": "Additional Notes",
"isExpanded": "true",
"questions": [
{
"label": "Mental Health Assessment Notes",
"label": "Clinician Notes",
"type": "obs",
"questionOptions": {
"rendering": "textarea",
"concept": "165095AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"rows": "",
"conceptMappings": [
{
"type": "AMPATH",
"value": "1915"
},
{
"type": "AMPATH",
"value": "1915"
Expand All @@ -612,7 +642,7 @@
}
]
},
"id": "phq9Notes"
"id": "clinicianNotes"
}
]
}
Expand All @@ -629,5 +659,6 @@
"uuid": "2069bd57-d534-3de9-ae24-f1d4e4b2de83",
"referencedForms": [],
"encounterType": "36db5123-0ad5-41c0-9037-625b46e0ceef",
"encounter": "Mental Health Assessment"
}
"encounter": "Mental Health Assessment",
"description": "A form used for screening, diagnosing, monitoring and measuring the severity of depression"
}