Mental Health Screening

When to Use This Skill

Use when a clinician needs to evaluate mental health screening scores, track symptom trends over time, and assess treatment response.

Clinical Workflow

1. Use fhir_read to retrieve Patient demographics
2. Use fhir_search to pull screening Observation resources: PHQ-9 (LOINC 44249-1), GAD-7 (LOINC 70274-6), AUDIT-C (LOINC 75626-2), PHQ-2 (LOINC 55758-7), Columbia CSSRS (LOINC 93373-2)
3. Pull historical screening scores for trend analysis
4. Use fhir_search to pull active Condition resources for mental health diagnoses
5. Use fhir_search to pull active MedicationRequest for psychotropic medications (antidepressants, anxiolytics, mood stabilizers, antipsychotics)
6. Score interpretation per validated scales (see references/phq9-gad7-scoring.md)
7. Assess treatment response: compare current scores to baseline and post-medication initiation
8. Flag urgent findings: PHQ-9 item 9 (suicidal ideation) positive, severe scores, worsening trajectory

FHIR Resources

• Observation -- PHQ-9 (44249-1), GAD-7 (70274-6), AUDIT-C (75626-2), PHQ-2 (55758-7), CSSRS (93373-2)
• Condition -- Mental health diagnoses (MDD, GAD, PTSD, bipolar, SUD)
• MedicationRequest -- Psychotropic medications
• Patient -- Demographics

FHIR Query Examples

Pull PHQ-9 Trend

fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&code=44249-1&_sort=date&_count=20")

Pull GAD-7 Scores

fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&code=70274-6&_sort=date&_count=20")

Pull AUDIT-C

fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&code=75626-2&_sort=-date&_count=5")

Clinical Guidelines

• USPSTF Grade B: depression screening for all adults
• USPSTF Grade B: anxiety screening for adults
• USPSTF Grade B: unhealthy alcohol use screening
• APA Practice Guidelines for Major Depressive Disorder
• SAMHSA screening and brief intervention guidelines

Interpretation Guide

• PHQ-9: 0-4 minimal, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe. Treatment threshold: >=10
• GAD-7: 0-4 minimal, 5-9 mild, 10-14 moderate, 15-21 severe. Treatment threshold: >=10
• AUDIT-C: positive screen >=3 (women), >=4 (men)
• PHQ-9 Item 9 (suicidal ideation): ANY positive response requires immediate safety assessment
• Treatment response: >=50% reduction in PHQ-9 = response; score <5 = remission
• If PHQ-9 not improving after 4-8 weeks of adequate therapy, consider dose adjustment, augmentation, or referral

Safety

• Never fabricate clinical data -- only report what FHIR returns
• Flag critical/abnormal values immediately
• Scope all FHIR queries to the authenticated patient
• Use standard terminology (LOINC, SNOMED CT, RxNorm, ICD-10)
• Present data in clinician-friendly format with reference ranges