Facilitating Reuse of Mental Health Questionnaires via Knowledge Graphs

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Santos, Henrique
Rook, Kelsey
Pinheiro, Paulo
Gruen, Daniel M.
Chorpita, Bruce F.
McGuinness, Deborah L.
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mental health , questionnaires , semantic questionnaires
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Questionnaires are one of the most common instrument types for screening patients for mental disorders. They are composed of items whose answers are typically scored to determine the elevation on a specified dimension, and hence the statistical probabilities associated with the corresponding disorder or diagnosis. The Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) questionnaire, for instance, measure levels of depression and anxiety respectively, and can be used to support diagnosis of depression and generalized anxiety disorder. Some questionnaires are multidimensional, such as the Revised Children's Anxiety and Depression Scale (RCADS), and can thereby estimate elevations on multiple dimensions that underlie a variety of disorders. Mental health screening questionnaires are designed so that each item assesses specific symptoms whose pattern of co-occurence (often organized in a subscale) allows estimation of how likely such symptoms would occur in the absence of the disorder whose symptoms the items represent. Questionnaire users typically estimate how likely a set of co-occuring symptoms would be (i.e., a score) in the general population as a strategy to estimate the likelihood that the respondent has a disorder warranting mental health services. The RCADS is a 47-item, youth self-report questionnaire with subscales (separation anxiety disorder, social phobia, generalized anxiety disorder, panic disorder, obsessive compulsive disorder, and major depressive disorder). It also yields a Total Anxiety Scale (sum of the 5 anxiety subscales) and a Total Internalizing Scale (sum of all 6 subscales). Items are rated on a 4-point Likert-scale from 0 ("never") to 3 ("always"). A Parent Version (RCADS-P) similarly assesses parent report of a youth’s symptoms across the same six subscales. Brief versions of the RCADS questionnaires are available as well (RCADS-25), yielding only three scores: Total Anxiety, Total Depression, and Total Anxiety and Depression. RCADS questionnaires have been translated to 19 languages. Recently there has been increased interest in supporting widespread adoption of common measures in mental health to support estimation and measurement of clinical dimensions across settings, contexts, and nations. However, the current measurement architecture in mental health is essentially based on a text-only document representation of each questionnaire, with limited knowledge of how they were created, how they relate to other questionnaires, how items relate to symptoms, which in turn relate to disorders, how short and long versions are related, etc. The result is significant constraints on the types of use cases that can be supported, with especially limited support for such pursuits as shortening the number of items, translations to new languages, reuse of items in new questionnaires, and even the combination of items from different questionnaires. We present our progress towards tackling these challenges. Our solution is composed of: (1) a modeling of mental health symptoms, scales, disorders, and their relationships as an ontology; (2) the representation of questionnaire instruments as a knowledge graph, using standardized terminology; and (3) a software infrastructure for operationalizing the management and distributions of semantic questionnaires (Semantic Instrument Repository - SIR). Using the RCADS questionnaires as a use case, we encode their (sub)scales in an ontology, reusing existing terminology from relevant sources. We expand our base Human-Aware Science Ontology (HAScO) to include questionnaire structure, and propose a new ontology for encoding and aligning mental health terminology, such as symptoms, scales, and disorders. SIR supports authoring, curation, and dissemination of questionnaires, their elements, and relationships between these elements, thus allowing questionnaires to contain mental health semantics.
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The Healthcare and Life Sciences Symposium
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