The PHQ-9 item-9 crisis card routed every "de" locale to the Germany-only
TelefonSeelsorge freephone lines. Those numbers don't connect from Austria
or Switzerland, so a Swiss or Austrian user in crisis was shown dead numbers
first on the one surface where that costs the most.
Add dedicated Austria (Telefonseelsorge 142) and Switzerland (Die
Dargebotene Hand 143) resource sets. `User.locale` only ever stores a bare
short code today, so an unqualified "de" now resolves to a combined
DE/AT/CH set (112 first, then every country's own line) instead of
defaulting to Germany; a region-qualified tag resolves to the exact country
when one is available.
Two new self-report instruments join the mental-wellbeing engine on the
existing PHQ-9 / GAD-7 infrastructure:
- WHO-5 Well-Being Index: 5 items on the 6-point 5..0 scale over the last
two weeks; the reported total is raw-sum x 4 (0-100) per the official
WHO scoring (WHO/UCN/MSD/MHE/2024.1, CC BY-NC-SA 3.0 IGO). A total of
50 or below follows the WHO comment (below 50 = indication for further
assessment).
- Sleep Condition Indicator: 8 DSM-5-aligned items, 0-4 each with
item-specific anchors, total 0-32, higher = better sleep; a total of
16 or below maps to the probable-insomnia range of the source
publication (Espie et al., BMJ Open 2014;4:e004183, CC BY-NC,
(c) Sleepio Limited).
The instrument registry generalises rather than forking: per-item answer
ceilings, option order/label schemes, recall-stem captions, a reported-
score multiplier, score direction (higher-is-better inverts the follow-up
threshold), per-instrument attribution lines, and the validated-item
locale set are now instrument properties. Scoring stays server-
authoritative; the create route validates the per-instrument answer
ceiling and projects the total onto a COMPUTED WHO5_SCORE / SCI_SCORE
measurement row (never client-attributable), which also auto-satisfies a
planned screening reminder. Migration 0226 adds the enum values
(additive, idempotent). OpenAPI regenerated.
Neither instrument carries a self-harm item; the PHQ-9 item-9 crisis
routing is unchanged.
Pin the highest-consequence numbers in the release: every PHQ-9/GAD-7 severity
band edge, the >=10 action threshold, and the item-9 ANY-non-zero safety flag
(true on item9 1/2/3, false on 0 or for GAD-7). Add a POST happy-path test
that would have caught the dead-on-arrival bug — a valid body now parses,
persists server-authoritative scoring, writes the derived score measurement,
and surfaces the crisis set on a positive item 9.
The PHQ-9/GAD-7 item wordings rendered in English for es/fr/it/pl users
(de was already validated). Replace them with the officially validated,
public-domain Pfizer/PRIME-MD localized screener wordings (distributed via
the MAPI Research Trust) rather than ad-hoc translations — re-wording a
validated instrument invalidates the score. Localize the crisis-resource
copy too: translate the descriptive parentheticals while keeping the org
proper-nouns (TelefonSeelsorge, Nummer gegen Kummer, krisenchat,
Find a Helpline) and the US brand lines (988, Crisis Text Line) verbatim.
Add the new mental-wellbeing module label/description and the nav label
across all six locales.
Add the validated mental-health self-assessment surface, beside mood tracking
(never replacing it) and off by default:
- MentalHealthAssessment stores per-item answers in a single AES-256-GCM Bytes
blob (registered for key rotation); only the server-authoritative total,
severity band, and item-9 flag are denormalised. The total projects to a
PHQ9_SCORE / GAD7_SCORE measurement row so the trend rides existing infra
without ever exposing item content.
- Item-9 safety: any non-zero PHQ-9 self-harm answer surfaces a calm,
locale-aware crisis-resource set (DE: TelefonSeelsorge 0800 111 0 111 / 112;
international fallback) and stamps crisisShownAt. No clinical interpretation,
no AI ingestion of item content, no third-party alerting.
- API + OpenAPI: POST/GET /api/mental-health/assessments; the response excludes
raw item answers by construction. Required Pfizer/PHQ attribution lives in the
instrument module, rendered verbatim.
The screener scores are kept off the Coach snapshot and MCP surfaces, and out of
exports by default — item content never reaches the AI pipeline.
Marc-André Bombeck