Clinical instruments

Nyra ships two validated instruments today: PHQ-9 (depression, 0 to 27) and GAD-7 (anxiety, 0 to 21). Both are administered on days 1, 7, and 14 of the 14-day arc.

Wording is exact

Item text, response options, and item order match the validated instruments verbatim. The four PHQ-9 / GAD-7 response options always read:

1. Not at all
2. Several days
3. More than half the days
4. Nearly every day

These never change. Translations use published validated translations, not LLM output.

Scoring

PHQ-9 severity bands:

• 0 to 4: Minimal or none
• 5 to 9: Mild
• 10 to 14: Moderate
• 15 to 19: Moderately severe
• 20 to 27: Severe

GAD-7 severity bands:

• 0 to 4: Minimal
• 5 to 9: Mild
• 10 to 14: Moderate
• 15 to 21: Severe

The clinician sees the total, the band, and the per-item response array. The patient sees only that their submission was recorded; severity labels and trajectory live in the clinician surface, never the patient one.

Change thresholds

PHQ-9: a five-point change is the minimal clinically important difference. GAD-7: about four points. Smaller swings between captures are treated as informational, not as evidence of treatment response.

Item 9 escalation

PHQ-9 item 9 ("Thoughts that you would be better off dead or of hurting yourself in some way") triggers immediate crisis escalation regardless of total score. The submit handler:

1. Sets crisisFlagged: true on the scale result row.
2. Opens CrisisResourceSheet with 988 and 911 visible as plain readable text.
3. Writes a risk_events row at level=crisis so the clinician's risk queue refreshes immediately via postgres_changes.

The boundary is restated up-front on the patient's first screen: this app is not monitored in real time and cannot be the first line of crisis response.