#include "cesdr.h"
#include "core/camcopsapp.h"
#include "lib/version.h"
#include "lib/stringfunc.h"
#include "lib/uifunc.h"
#include "maths/mathfunc.h"
#include "questionnairelib/questionnaire.h"
#include "questionnairelib/qumcqgrid.h"
#include "questionnairelib/qutext.h"
#include "tasklib/taskfactory.h"
#include "tasklib/taskregistrar.h"
using mathfunc::countNull;
using mathfunc::countWhere;
using mathfunc::noneNull;
using mathfunc::sumInt;
using mathfunc::totalScorePhrase;
using stringfunc::standardResult;
using stringfunc::strnum;
using stringfunc::strseq;
const int FIRST_Q = 1;
const int N_QUESTIONS = 20;
const int MAX_QUESTION_SCORE = 60;
const int CAT_NONCLINICAL = 0;
const int CAT_SUB = 1;
const int CAT_POSS_MAJOR = 2;
const int CAT_PROB_MAJOR = 3;
const int CAT_MAJOR = 4;
const int DEPRESSION_RISK_THRESHOLD = 16;
const int FREQ_NOT_AT_ALL = 0;
const int FREQ_1_2_DAYS_LAST_WEEK = 1;
const int FREQ_3_4_DAYS_LAST_WEEK = 2;
const int FREQ_5_7_DAYS_LAST_WEEK = 3;
const int FREQ_DAILY_2_WEEKS = 4;
const int POSS_MAJOR_THRESH = 2;
const int PROB_MAJOR_THRESH = 3;
const int MAJOR_THRESH = 4;
const QString QPREFIX("q");
const QString Cesdr::CESDR_TABLENAME("cesdr");
void initializeCesdr(TaskFactory& factory)
{
static TaskRegistrar<Cesdr> registered(factory);
}
Cesdr::Cesdr(CamcopsApp& app, DatabaseManager& db, const int load_pk) :
Task(app, db, CESDR_TABLENAME, false, false, false),
m_questionnaire(nullptr)
{
addFields(strseq(QPREFIX, FIRST_Q, N_QUESTIONS), QMetaType::fromType<int>());
load(load_pk); // MUST ALWAYS CALL from derived Task constructor.
}
// ============================================================================
// Class info
// ============================================================================
QString Cesdr::shortname() const
{
return "CESD-R";
}
QString Cesdr::longname() const
{
return tr("Center for Epidemiologic Studies Depression Scale (Revised)");
}
QString Cesdr::description() const
{
return tr("20-item self-report depression scale.");
}
Version Cesdr::minimumServerVersion() const
{
return Version(2, 2, 8);
}
QString Cesdr::infoFilenameStem() const
{
return "cesd";
}
// ============================================================================
// Instance info
// ============================================================================
bool Cesdr::isComplete() const
{
return noneNull(values(strseq(QPREFIX, FIRST_Q, N_QUESTIONS)));
}
QStringList Cesdr::summary() const
{
return QStringList{
totalScorePhrase(totalScore(), MAX_QUESTION_SCORE),
standardResult(xstring("depression_or_risk_of"),
uifunc::yesNoUnknown(totalScore() >= DEPRESSION_RISK_THRESHOLD)),
};
}
QStringList Cesdr::detail() const
{
QStringList lines = completenessInfo();
lines += summary();
const int cat = depressionCategory();
lines.append("");
lines.append(xstring("category_" + QString::number(cat)));
return lines;
}
int Cesdr::depressionCategory() const
{
/*
* Determining CESD-R categories
* See: https://cesd-r.com/cesdr/
*/
if (totalScore() < DEPRESSION_RISK_THRESHOLD) {
return CAT_SUB;
}
// DSM Categories
const QVector<int> qs_dysphoria = {2, 4, 6};
const QVector<int> qs_anhedonia = {8, 10};
const QVector<int> qs_appetite = {1, 18};
const QVector<int> qs_sleep = {5, 11, 19};
const QVector<int> qs_thinking = {3, 20};
const QVector<int> qs_guilt = {9, 17};
const QVector<int> qs_tired = {7, 16};
const QVector<int> qs_movement = {12, 13};
const QVector<int> qs_suicidal = {14, 15};
const QVector<QVector<int>> non_anhedonia_groups{
qs_appetite, qs_sleep, qs_movement, qs_tired, qs_guilt,
qs_thinking, qs_suicidal
};
// Dysphoria or anhedonia must be present at frequency FREQ_DAILY_2_WEEKS
const bool anhedonia_criterion = fulfilsGroupCriteria(qs_dysphoria, true) ||
fulfilsGroupCriteria(qs_anhedonia, true);
if (anhedonia_criterion) {
int categoryCountHighFrequency = 0;
int categoryCountLowerFrequency = 0;
for (auto qgroup : non_anhedonia_groups) {
if (fulfilsGroupCriteria(qgroup, true)) {
// Category contains an answer == FREQ_DAILY_2_WEEKS
categoryCountHighFrequency += 1;
}
if (fulfilsGroupCriteria(qgroup, false)) {
// Category contains an answer == FREQ_DAILY_2_WEEKS or FREQ_5_7_DAYS_LAST_WEEK
categoryCountLowerFrequency += 1;
}
}
if (categoryCountHighFrequency >= MAJOR_THRESH) {
// Anhedonia or dysphoria (at FREQ_DAILY_2_WEEKS)
// plus 4 other symptom groups at FREQ_DAILY_2_WEEKS
return CAT_MAJOR;
} else if (categoryCountLowerFrequency >= PROB_MAJOR_THRESH) {
// Anhedonia or dysphoria (at FREQ_DAILY_2_WEEKS)
// plus 3 other symptom groups at FREQ_DAILY_2_WEEKS or FREQ_5_7_DAYS_LAST_WEEK
return CAT_PROB_MAJOR;
} else if (categoryCountLowerFrequency >= POSS_MAJOR_THRESH) {
// Anhedonia or dysphoria (at FREQ_DAILY_2_WEEKS)
// plus 2 other symptom groups at FREQ_DAILY_2_WEEKS or FREQ_5_7_DAYS_LAST_WEEK
return CAT_POSS_MAJOR;
}
}
const int cesd_score = totalScore();
if (cesd_score >= DEPRESSION_RISK_THRESHOLD) {
// Total CESD-style score >= 16 but doesn't meet other criteria.
return CAT_SUB;
}
return CAT_NONCLINICAL;
}
OpenableWidget* Cesdr::editor(const bool read_only)
{
const NameValueOptions options{
{xstring("a0"), FREQ_NOT_AT_ALL},
{xstring("a1"), FREQ_1_2_DAYS_LAST_WEEK},
{xstring("a2"), FREQ_3_4_DAYS_LAST_WEEK},
{xstring("a3"), FREQ_5_7_DAYS_LAST_WEEK},
{xstring("a4"), FREQ_DAILY_2_WEEKS},
};
const int question_width = 50;
const QVector<int> option_widths{10, 10, 10, 10, 10};
QuPagePtr page((new QuPage{
new QuText(xstring("instructions")),
(new QuMcqGrid(
{
QuestionWithOneField(xstring("q1"), fieldRef("q1")),
QuestionWithOneField(xstring("q2"), fieldRef("q2")),
QuestionWithOneField(xstring("q3"), fieldRef("q3")),
QuestionWithOneField(xstring("q4"), fieldRef("q4")),
QuestionWithOneField(xstring("q5"), fieldRef("q5")),
QuestionWithOneField(xstring("q6"), fieldRef("q6")),
QuestionWithOneField(xstring("q7"), fieldRef("q7")),
QuestionWithOneField(xstring("q8"), fieldRef("q8")),
QuestionWithOneField(xstring("q9"), fieldRef("q9")),
QuestionWithOneField(xstring("q10"), fieldRef("q10")),
QuestionWithOneField(xstring("q11"), fieldRef("q11")),
QuestionWithOneField(xstring("q12"), fieldRef("q12")),
QuestionWithOneField(xstring("q13"), fieldRef("q13")),
QuestionWithOneField(xstring("q14"), fieldRef("q14")),
QuestionWithOneField(xstring("q15"), fieldRef("q15")),
QuestionWithOneField(xstring("q16"), fieldRef("q16")),
QuestionWithOneField(xstring("q17"), fieldRef("q17")),
QuestionWithOneField(xstring("q18"), fieldRef("q18")),
QuestionWithOneField(xstring("q19"), fieldRef("q19")),
QuestionWithOneField(xstring("q20"), fieldRef("q20"))
},
options
))
->setTitle(xstring("stem"))
->setWidth(question_width, option_widths)
->setExpand(true)
->setQuestionsBold(false)
})->setTitle(xstring("title")));
auto questionnaire = new Questionnaire(m_app, {page});
questionnaire->setType(QuPage::PageType::Patient);
questionnaire->setReadOnly(read_only);
return questionnaire;
}
// ============================================================================
// Task-specific calculations
// ============================================================================
bool Cesdr::fulfilsGroupCriteria(const QVector<int>& qnums,
bool nearly_every_day_2w) const
{
for (const int qnum : qnums) {
const int v = valueInt(stringfunc::strnum("q", qnum));
if (v == FREQ_DAILY_2_WEEKS) {
return true;
}
if (v == FREQ_5_7_DAYS_LAST_WEEK && !nearly_every_day_2w) {
// A lower threshold for some symptoms, when nearly_every_day_2w
// is false.
return true;
}
}
return false;
}
int Cesdr::totalScore() const
{
// So that the CESD-R has the same range as the CESD (the "CESD-style
// score"), the values for the top two responses are given the same value.
// See: https://cesd-r.com/cesdr/
QVector<QVariant> responses = values(strseq(QPREFIX, FIRST_Q, N_QUESTIONS));
// Sum the response values, and subtract the count of answers marked as
// occurring daily. Makes the 5-7 and daily responses value-quivalent, so
// scoring is out of 60 and comparable to CESD.
return sumInt(responses) - countWhere(responses,
QVector<QVariant>{FREQ_DAILY_2_WEEKS});
}
int Cesdr::numNull(const int first, const int last) const
{
return countNull(values(strseq(QPREFIX, first, last)));
}