feat(mental-health): ask the PHQ-9 functional follow-up as the last question

The PHQ-9's validated functional-impairment item left the web wizard
with the review step; the API kept the field but no web client captured
it. It returns as a regular question 10 of 10 in the same style as the
nine scored items: optional per the instrument (submit stays armed
without an answer, a second tap clears the selection, a short hint says
skipping is fine) and never scored into the total. The answer rides the
existing functionalDifficulty field; GAD-7 keeps its seven steps. The
validated wording returns to all six locales.

messages/de.json

@@ -7664,6 +7664,14 @@
       "2": "An mehr als der Hälfte der Tage",
       "3": "Beinahe jeden Tag"
     },
+    "functionalTitle": "Wenn du eine oder mehrere Beschwerden angegeben hast: Wie sehr haben diese deine Arbeit, deinen Haushalt oder den Umgang mit anderen Menschen erschwert?",
+    "functional": {
+      "0": "Überhaupt nicht erschwert",
+      "1": "Etwas erschwert",
+      "2": "Sehr erschwert",
+      "3": "Extrem erschwert"
+    },
+    "functionalOptionalHint": "Optional — du kannst auch ohne Antwort auf diese Frage absenden.",
     "result": {
       "title": "Dein Ergebnis",
       "totalLabel": "Gesamtwert",

messages/en.json

@@ -7664,6 +7664,14 @@
       "2": "More than half the days",
       "3": "Nearly every day"
     },
+    "functionalTitle": "If you checked off any problems, how difficult have these made it to do your work, take care of things at home, or get along with other people?",
+    "functional": {
+      "0": "Not difficult at all",
+      "1": "Somewhat difficult",
+      "2": "Very difficult",
+      "3": "Extremely difficult"
+    },
+    "functionalOptionalHint": "Optional — you can submit without answering this question.",
     "result": {
       "title": "Your result",
       "totalLabel": "Total score",

messages/es.json

@@ -7664,6 +7664,14 @@
       "2": "Más de la mitad de los días",
       "3": "Casi todos los días"
     },
+    "functionalTitle": "Si marcaste algún problema, ¿cuánta dificultad te han causado para trabajar, ocuparte de la casa o relacionarte con otras personas?",
+    "functional": {
+      "0": "Ninguna dificultad",
+      "1": "Algo de dificultad",
+      "2": "Mucha dificultad",
+      "3": "Dificultad extrema"
+    },
+    "functionalOptionalHint": "Opcional: puedes enviar sin responder esta pregunta.",
     "result": {
       "title": "Tu resultado",
       "totalLabel": "Puntuación total",

messages/fr.json

@@ -7664,6 +7664,14 @@
       "2": "Plus de la moitié des jours",
       "3": "Presque tous les jours"
     },
+    "functionalTitle": "Si tu as coché des problèmes, à quel point t'ont-ils gêné(e) dans ton travail, à la maison ou dans tes relations avec les autres ?",
+    "functional": {
+      "0": "Pas du tout gênant",
+      "1": "Un peu gênant",
+      "2": "Très gênant",
+      "3": "Extrêmement gênant"
+    },
+    "functionalOptionalHint": "Facultatif — tu peux envoyer sans répondre à cette question.",
     "result": {
       "title": "Ton résultat",
       "totalLabel": "Score total",

messages/it.json

@@ -7664,6 +7664,14 @@
       "2": "Più della metà dei giorni",
       "3": "Quasi ogni giorno"
     },
+    "functionalTitle": "Se hai indicato dei problemi, quanto ti hanno reso difficile lavorare, occuparti della casa o andare d'accordo con gli altri?",
+    "functional": {
+      "0": "Per niente difficile",
+      "1": "Un po' difficile",
+      "2": "Molto difficile",
+      "3": "Estremamente difficile"
+    },
+    "functionalOptionalHint": "Facoltativo — puoi inviare anche senza rispondere a questa domanda.",
     "result": {
       "title": "Il tuo risultato",
       "totalLabel": "Punteggio totale",

messages/pl.json

@@ -7664,6 +7664,14 @@
       "2": "Więcej niż połowę dni",
       "3": "Niemal codziennie"
     },
+    "functionalTitle": "Jeśli zaznaczyłeś(-aś) jakiekolwiek problemy, na ile utrudniły Ci one pracę, prowadzenie domu lub kontakty z innymi ludźmi?",
+    "functional": {
+      "0": "Wcale nie utrudniły",
+      "1": "Trochę utrudniły",
+      "2": "Bardzo utrudniły",
+      "3": "Skrajnie utrudniły"
+    },
+    "functionalOptionalHint": "Opcjonalne — możesz wysłać bez odpowiedzi na to pytanie.",
     "result": {
       "title": "Twój wynik",
       "totalLabel": "Wynik łączny",

src/components/mental-health/check-in-wizard.tsx

@@ -47,8 +47,8 @@ export function CheckInWizard({
   isError,
 }: {
   instrument: InstrumentId;
-  /** Submit the completed check-in. */
-  onSubmit: (items: number[]) => void;
+  /** Submit the completed check-in (+ the optional PHQ-9 follow-up). */
+  onSubmit: (items: number[], functionalDifficulty?: number) => void;
   /** Return to the landing (abandons the in-progress check-in). */
   onBack: () => void;
   isPending: boolean;
@@ -57,15 +57,28 @@ export function CheckInWizard({
   const { t } = useTranslations();
   const key = lower(instrument);
   const itemCount = INSTRUMENTS[instrument].itemCount;
+  // v1.27.8 — the PHQ-9 asks its validated functional-impairment
+  // follow-up as a regular LAST question (10 of 10) instead of a
+  // separate review-step widget. It is OPTIONAL per the instrument
+  // (answering is not required to submit) and never scores into the
+  // total — the value rides the existing `functionalDifficulty` API
+  // field. GAD-7 has no such item and keeps its 7 steps.
+  const hasFunctionalStep = instrument === "PHQ9";
+  const totalSteps = itemCount + (hasFunctionalStep ? 1 : 0);
 
   const [step, setStep] = useState(1);
   const [items, setItems] = useState<number[]>(() =>
     Array(itemCount).fill(UNANSWERED),
   );
+  const [functional, setFunctional] = useState<number>(UNANSWERED);
 
-  const onLast = isLastStep(step, itemCount);
+  const onFunctionalStep = hasFunctionalStep && step === itemCount + 1;
+  const onLast = isLastStep(step, totalSteps);
   const questionIndex = step - 1; // 0-based item index for the current question
   const complete = isComplete(items);
+  const questionLabel = onFunctionalStep
+    ? t("mentalHealth.functionalTitle")
+    : t(`mentalHealth.items.${key}.${step}`);
 
   // a11y: announce each step by moving focus to its heading (the question
   // text). Mirrors the medication dialog's per-step title focus so a
@@ -77,6 +90,13 @@ export function CheckInWizard({
   }, [step]);
 
   function selectAnswer(value: number) {
+    if (onFunctionalStep) {
+      // Optional follow-up: selecting never advances (it IS the last
+      // step) and tapping the selected option again clears it — the
+      // answer stays skippable right up to submit.
+      setFunctional((prev) => (prev === value ? UNANSWERED : value));
+      return;
+    }
     setItems((prev) => {
       const next = [...prev];
       next[questionIndex] = value;
@@ -85,7 +105,7 @@ export function CheckInWizard({
     // Forward-on-select: advance to the next question. On the last question
     // the selection stays visible and the footer submit arms — submitting is
     // a deliberate second tap, never a side effect of answering.
-    if (!onLast) setStep((s) => nextStep(s, itemCount));
+    if (!onLast) setStep((s) => nextStep(s, totalSteps));
   }
 
   return (
@@ -123,7 +143,7 @@ export function CheckInWizard({
             <p className="text-muted-foreground text-xs">
               {t("mentalHealth.progress", {
                 current: step,
-                total: itemCount,
+                total: totalSteps,
               })}
             </p>
             <h2
@@ -131,27 +151,39 @@ export function CheckInWizard({
               tabIndex={-1}
               className="scroll-mt-4 text-base font-medium outline-none"
             >
-              {t(`mentalHealth.items.${key}.${step}`)}
+              {questionLabel}
             </h2>
+            {onFunctionalStep && (
+              <p className="text-muted-foreground text-xs">
+                {t("mentalHealth.functionalOptionalHint")}
+              </p>
+            )}
             <div
               className="flex flex-col gap-2"
               role="group"
-              aria-label={t(`mentalHealth.items.${key}.${step}`)}
+              aria-label={questionLabel}
             >
-              {SCALE.map((v) => (
-                <Button
-                  key={v}
-                  type="button"
-                  // 44px touch-target floor (WCAG 2.5.5).
-                  className="min-h-11 justify-start"
-                  variant={items[questionIndex] === v ? "default" : "outline"}
-                  aria-pressed={items[questionIndex] === v}
-                  onClick={() => selectAnswer(v)}
-                  disabled={isPending}
-                >
-                  {t(`mentalHealth.options.${v}`)}
-                </Button>
-              ))}
+              {SCALE.map((v) => {
+                const selected = onFunctionalStep
+                  ? functional === v
+                  : items[questionIndex] === v;
+                return (
+                  <Button
+                    key={v}
+                    type="button"
+                    // 44px touch-target floor (WCAG 2.5.5).
+                    className="min-h-11 justify-start"
+                    variant={selected ? "default" : "outline"}
+                    aria-pressed={selected}
+                    onClick={() => selectAnswer(v)}
+                    disabled={isPending}
+                  >
+                    {onFunctionalStep
+                      ? t(`mentalHealth.functional.${v}`)
+                      : t(`mentalHealth.options.${v}`)}
+                  </Button>
+                );
+              })}
             </div>
 
             {isError && (
@@ -177,7 +209,7 @@ export function CheckInWizard({
             <Button
               type="button"
               className="h-11"
-              onClick={() => setStep((s) => nextStep(s, itemCount))}
+              onClick={() => setStep((s) => nextStep(s, totalSteps))}
               disabled={items[questionIndex] < 0}
               data-slot="check-in-next"
             >
@@ -187,7 +219,9 @@ export function CheckInWizard({
             <Button
               type="button"
               className="h-11"
-              onClick={() => onSubmit(items)}
+              onClick={() =>
+                onSubmit(items, functional >= 0 ? functional : undefined)
+              }
               disabled={!complete || isPending}
               aria-busy={isPending || undefined}
               data-slot="check-in-submit"

src/components/mental-health/mental-wellbeing.tsx

@@ -93,15 +93,15 @@ export function MentalWellbeing() {
     setPhase("choose");
   }
 
-  // v1.27.6 — the review step (and with it the optional functional-difficulty
-  // follow-up) left the web wizard; the check-in submits the scored items
-  // directly after the last question. The API keeps accepting
-  // `functionalDifficulty` for clients that still capture it.
-  function submit(items: number[]) {
+  // v1.27.8 — the PHQ-9 functional-impairment follow-up returned as the
+  // wizard's regular last question (optional, unscored); the value rides
+  // the existing `functionalDifficulty` field when the user answered it.
+  function submit(items: number[], functionalDifficulty?: number) {
     mutation.mutate({
       instrument,
       items,
       locale,
+      ...(functionalDifficulty !== undefined ? { functionalDifficulty } : {}),
     });
   }