This approach, supported through the Texas Medication Algorithm Project, has shown improved patient outcomes after one year, such as better clinical adherence to prescribing medications. Further recommendations from the US Preventative Task Force (USPTF) include screening all adults over the age of 18 with a standardized instrument and providing further assessment for those who screen positive. Further, it can be utilized to determine whether or not the patient has improved since the last visit to better inform the treatment plan.Ĭurrent American Psychological Association (APA) guidelines for the treatment of MDD encourage utilizing standardized instruments, such as the PHQ 9, for initial patient psychiatric assessment, determining and implementing therapeutic protocols, and monitoring treatment progress. These grades have an 88% consistency rate with clinical diagnoses of major depression severity. Responses to the questionnaire are graded, i.e., the total score can be used to indicate mild, moderate, or severe episodes as it relates to the patient’s major depression. Since its publication in 2001, the PHQ 9 has been prolific in the screening and/or monitoring of major depression with over 11,000 citations. These instruments, such as the Hamilton Depression Screen or Patient Health Questionnaire 9 (PHQ 9), are standardized tools that track patient improvement. The use of surveys to monitor progress has the added benefit of introducing metric-based instruments. Over the last two decades, a second method has garnered popularity and relies on self-administered surveys that ask patients to rate individual symptoms.

Instead, the clinician uses this approach to make an individualized assessment of the patient’s status, i.e., conducts a risk/benefit evaluation in relation to treatment options. However, responses are not quantified using traditional methods. During these visits, clinicians assess the patient's depression by evaluating symptom severity with questions mimicking DSM criteria. Visits may be with a mental health provider or primary care physician. Traditional methods require in-person, monthly visits to medical clinics to determine treatment efficacy and/or fill prescriptions. Monitoring has occurred in a few different ways. Individuals diagnosed with MDD are monitored on a regular basis for treatment response and overall status. While MDD is not curable, it is treatable. Recent surveys have shown these upward trends continuing. Since the beginning of the COVID-19 pandemic, the rate of US adults experiencing symptoms of depression may have tripled. In 2017, the National Institute of Mental Health estimated 17.3 million people in the United States suffered at least one major depression episode. With an annual incidence of 10.4% and a lifetime prevalence of 20.6%, this condition ranks among the most common mental disorders. Major Depressive Disorder (MDD) affects millions of individuals in the United States. It is our hope that future studies may examine the efficacy of the Alexa format in improving the at-home clinical treatment of depression. User experience assessments further showed a preference for the novel version over the traditional format. With the benefit of user instruction in a clinical environment, the novel Alexa delivery system was shown to be consistent with the paper version giving evidence of reliability between the two formats. Further qualitative responses supported these findings with 85.7% of participants indicating a willingness to use the device at home. Quantitative UEQ results showed significantly higher overall positive attitudes towards the Alexa format with higher subscale scores on attractiveness, stimulation, and novelty. Assessments between PHQ 9 total scores for the Alexa and paper version showed a high degree of reliability (α = .86). Patients additionally completed a 26-item User Experience Questionnaire (UEQ) and open-ended questionnaire at each session.

Patients were randomly assigned to a version (voice vs paper) completing the alternate format at the next appointment. Forty-one newly admitted patients to a behavioral medicine clinic completed the PHQ 9 at two separate time points (first appointment and one-month follow up). The aim of this study was to measure the reliability and usability of a novel voice-based delivery system of the PHQ 9 using Amazon Alexa within a patient population. Self-administered surveys, such as the Patient Health Questionnaire 9 (PHQ 9), have been leveraged to inform treatment practice of Major Depressive Disorder (MDD).

Over the last two decades, metric-based instruments have garnered popularity in mental health.

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