#!/usr/bin/env python
"""
camcops_server/tasks/phq8.py
===============================================================================
Copyright (C) 2012, University of Cambridge, Department of Psychiatry.
Created by Rudolf Cardinal (rnc1001@cam.ac.uk).
This file is part of CamCOPS.
CamCOPS is free software: you can redistribute it and/or modify
it under the terms of the GNU General Public License as published by
the Free Software Foundation, either version 3 of the License, or
(at your option) any later version.
CamCOPS is distributed in the hope that it will be useful,
but WITHOUT ANY WARRANTY; without even the implied warranty of
MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
GNU General Public License for more details.
You should have received a copy of the GNU General Public License
along with CamCOPS. If not, see <https://www.gnu.org/licenses/>.
===============================================================================
"""
import logging
from typing import Any, Dict, List, Tuple, Type
from cardinal_pythonlib.stringfunc import strseq
from sqlalchemy.ext.declarative import DeclarativeMeta
from sqlalchemy.sql.sqltypes import Boolean, Integer
from camcops_server.cc_modules.cc_constants import CssClass
from camcops_server.cc_modules.cc_ctvinfo import CtvInfo, CTV_INCOMPLETE
from camcops_server.cc_modules.cc_db import add_multiple_columns
from camcops_server.cc_modules.cc_fhir import (
FHIRAnsweredQuestion,
FHIRAnswerType,
FHIRQuestionType,
)
from camcops_server.cc_modules.cc_html import answer, get_yes_no, tr, tr_qa
from camcops_server.cc_modules.cc_request import CamcopsRequest
from camcops_server.cc_modules.cc_sqla_coltypes import (
SummaryCategoryColType,
)
from camcops_server.cc_modules.cc_summaryelement import SummaryElement
from camcops_server.cc_modules.cc_task import (
get_from_dict,
Task,
TaskHasPatientMixin,
)
from camcops_server.cc_modules.cc_text import SS
from camcops_server.cc_modules.cc_trackerhelpers import (
TrackerAxisTick,
TrackerInfo,
TrackerLabel,
)
log = logging.getLogger(__name__)
# =============================================================================
# PHQ-8
# =============================================================================
class Phq8Metaclass(DeclarativeMeta):
# noinspection PyInitNewSignature
def __init__(
cls: Type["Phq8"],
name: str,
bases: Tuple[Type, ...],
classdict: Dict[str, Any],
) -> None:
add_multiple_columns(
cls,
"q",
1,
cls.N_QUESTIONS,
minimum=0,
maximum=3,
comment_fmt="Q{n} ({s}) (0 not at all - 3 nearly every day)",
comment_strings=[
"anhedonia",
"mood",
"sleep",
"energy",
"appetite",
"self-esteem/guilt",
"concentration",
"psychomotor",
],
)
super().__init__(name, bases, classdict)
[docs]class Phq8(TaskHasPatientMixin, Task, metaclass=Phq8Metaclass):
"""
Server implementation of the Phq8 task.
"""
__tablename__ = "phq8"
shortname = "PHQ-8"
provides_trackers = True
N_QUESTIONS = 8
MAX_SCORE = 3 * N_QUESTIONS
QUESTIONS = strseq("q", 1, N_QUESTIONS)
[docs] @staticmethod
def longname(req: "CamcopsRequest") -> str:
_ = req.gettext
return _("Patient Health Questionnaire 8-item depression scale")
[docs] def is_complete(self) -> bool:
if self.any_fields_none(self.QUESTIONS):
return False
if not self.field_contents_valid():
return False
return True
[docs] def get_trackers(self, req: CamcopsRequest) -> List[TrackerInfo]:
return [
TrackerInfo(
value=self.total_score(),
plot_label="PHQ-8 total score (rating depressive symptoms)",
axis_label=f"Score (out of {self.MAX_SCORE})",
axis_min=-0.5,
axis_max=self.MAX_SCORE + 0.5,
axis_ticks=[
TrackerAxisTick(24, "24"), # maximum
TrackerAxisTick(20, "20"),
TrackerAxisTick(15, "15"),
TrackerAxisTick(10, "10"),
TrackerAxisTick(5, "5"),
TrackerAxisTick(0, "0"),
],
horizontal_lines=[19.5, 14.5, 9.5, 4.5],
horizontal_labels=[
TrackerLabel(23, req.sstring(SS.SEVERE)),
TrackerLabel(17, req.sstring(SS.MODERATELY_SEVERE)),
TrackerLabel(12, req.sstring(SS.MODERATE)),
TrackerLabel(7, req.sstring(SS.MILD)),
TrackerLabel(2.25, req.sstring(SS.NONE)),
],
)
]
[docs] def get_clinical_text(self, req: CamcopsRequest) -> List[CtvInfo]:
if not self.is_complete():
return CTV_INCOMPLETE
return [
CtvInfo(
content=(
f"PHQ-8 total score "
f"{self.total_score()}/{self.MAX_SCORE} "
f"({self.severity(req)})"
)
)
]
[docs] def get_summaries(self, req: CamcopsRequest) -> List[SummaryElement]:
return self.standard_task_summary_fields() + [
SummaryElement(
name="total",
coltype=Integer(),
value=self.total_score(),
comment=f"Total score (/{self.MAX_SCORE})",
),
SummaryElement(
name="n_core",
coltype=Integer(),
value=self.n_core(),
comment="Number of core symptoms",
),
SummaryElement(
name="n_other",
coltype=Integer(),
value=self.n_other(),
comment="Number of other symptoms",
),
SummaryElement(
name="n_total",
coltype=Integer(),
value=self.n_total(),
comment="Total number of symptoms",
),
SummaryElement(
name="is_mds",
coltype=Boolean(),
value=self.is_mds(),
comment="PHQ8 major depressive syndrome?",
),
SummaryElement(
name="is_ods",
coltype=Boolean(),
value=self.is_ods(),
comment="PHQ8 other depressive syndrome?",
),
SummaryElement(
name="severity",
coltype=SummaryCategoryColType,
value=self.severity(req),
comment="PHQ8 depression severity",
),
]
def total_score(self) -> int:
return self.sum_fields(self.QUESTIONS)
def reaches_threshold(self, qnum: int) -> int:
# Checks if a symptom scores >=2, meaning "more than half the days".
# Kroenke et al. (2010); see Phq8::detail() in phq8.cpp
threshold = 2
value = getattr(self, "q" + str(qnum))
return 1 if value is not None and value >= threshold else 0
def n_core(self) -> int:
# Questions 1 and 2
return sum(self.reaches_threshold(qnum) for qnum in range(1, 2 + 1))
def n_other(self) -> int:
# Questions 3-8
return sum(self.reaches_threshold(qnum) for qnum in range(3, 8 + 1))
def n_total(self) -> int:
return self.n_core() + self.n_other()
def is_mds(self) -> bool:
# Kroenke et al. (2010); see Phq8::detail() in phq8.cpp
return self.n_core() >= 1 and self.n_total() >= 5
def is_ods(self) -> bool:
# Kroenke et al. (2010); see Phq8::detail() in phq8.cpp
return self.n_core() >= 1 and 2 <= self.n_total() <= 4
def severity(self, req: CamcopsRequest) -> str:
# Kroenke et al. (2010); see Phq8::severity() in phq8.cpp
total = self.total_score()
if total >= 20:
return req.sstring(SS.SEVERE)
elif total >= 15:
return req.sstring(SS.MODERATELY_SEVERE)
elif total >= 10:
return req.sstring(SS.MODERATE)
elif total >= 5:
return req.sstring(SS.MILD)
else:
return req.sstring(SS.NONE)
[docs] def get_task_html(self, req: CamcopsRequest) -> str:
answer_dict = {
None: None,
0: "0 — " + self.wxstring(req, "a0"),
1: "1 — " + self.wxstring(req, "a1"),
2: "2 — " + self.wxstring(req, "a2"),
3: "3 — " + self.wxstring(req, "a3"),
}
q_a = ""
for i in range(1, self.N_QUESTIONS + 1):
nstr = str(i)
q_a += tr_qa(
self.wxstring(req, "q" + nstr),
get_from_dict(answer_dict, getattr(self, "q" + nstr)),
)
h = """
<div class="{CssClass.SUMMARY}">
<table class="{CssClass.SUMMARY}">
{tr_is_complete}
{total_score}
{depression_severity}
{n_symptoms}
{mds}
{ods}
</table>
</div>
<div class="{CssClass.EXPLANATION}">
Ratings are over the last 2 weeks.
</div>
<table class="{CssClass.TASKDETAIL}">
<tr>
<th width="60%">Question</th>
<th width="40%">Answer</th>
</tr>
{q_a}
</table>
<div class="{CssClass.FOOTNOTES}">
[1] Sum for questions 1–8.
[2] Total score ≥20 severe, ≥15 moderately severe,
≥10 moderate, ≥5 mild, <5 none.<sup>[7]</sup>
[3] Number of questions 1–2 rated ≥2.<sup>[7]</sup>
[4] Number of questions 3–8 rated ≥2.<sup>[7]</sup>
[5] ≥1 core symptom and ≥5 total symptoms.<sup>[7]</sup>
[6] ≥1 core symptom and 2–4 total symptoms.<sup>[7]</sup>
[7] Kroenke et al. (2010), PMID 18752852.
</div>
""".format(
CssClass=CssClass,
tr_is_complete=self.get_is_complete_tr(req),
total_score=tr(
req.sstring(SS.TOTAL_SCORE) + " <sup>[1]</sup>",
answer(self.total_score()) + f" / {self.MAX_SCORE}",
),
depression_severity=tr_qa(
self.wxstring(req, "depression_severity") + " <sup>[2]</sup>",
self.severity(req),
),
n_symptoms=tr(
"Number of symptoms: core <sup>[3]</sup>, other "
"<sup>[4]</sup>, total",
answer(self.n_core())
+ "/2, "
+ answer(self.n_other())
+ "/6, "
+ answer(self.n_total())
+ "/8",
),
mds=tr_qa(
self.wxstring(req, "mds") + " <sup>[5]</sup>",
get_yes_no(req, self.is_mds()),
),
ods=tr_qa(
self.wxstring(req, "ods") + " <sup>[6]</sup>",
get_yes_no(req, self.is_ods()),
),
q_a=q_a,
)
return h
# No SNOMED CT codes for the PHQ-8 (just the PHQ-9), 2022-11-30.
[docs] def get_fhir_questionnaire(
self, req: "CamcopsRequest"
) -> List[FHIRAnsweredQuestion]:
items = [] # type: List[FHIRAnsweredQuestion]
answer_options = {} # type: Dict[int, str]
for index in range(4):
answer_options[index] = self.wxstring(req, f"a{index}")
for q_field in self.QUESTIONS:
items.append(
FHIRAnsweredQuestion(
qname=q_field,
qtext=self.xstring(req, q_field),
qtype=FHIRQuestionType.CHOICE,
answer_type=FHIRAnswerType.INTEGER,
answer=getattr(self, q_field),
answer_options=answer_options,
)
)
return items