• Posted December 22, 2025

Doctors' Questionnaires Confusing To Patients, Create Misleading Responses

Ever felt your eyes glazing over as you fill out the questionnaire you’ve been given by a doctor’s receptionist, trying to make heads or tails of it before your appointment?

You’re not alone, a new study says.

Confusion over symptom questionnaires is common, and likely hampers efforts to diagnose and treat physical and mental illnesses, researchers wrote Dec. 17 in JAMA Psychiatry.

The study focused on the Patient Health Questionnaire (PHQ), a widely used form that helps mental health professionals assess potential problems.

The longest version of the PHQ has only nine questions, but the form can be confusing to patients nevertheless, researchers found.

"This is the questionnaire that everyone fills out, and it's a such a common experience of being confused – it's potentially catastrophic," said lead researcher Zachary Cohen, an assistant professor of psychology at the University of Arizona in Tucson.

"Because everything we do in mental health research is dependent on, to a large extent, people's report of their mental health symptoms, if you don't have good data on that, you're building a house of cards,” he added in a news release.

Cohen said he became concerned about the PHQ and similar questionnaires 14 years ago, during his clinical training.

Nearly every patient he encountered would ask for some guidance on how to answer questions, and doctors often can only say, “Oh, just do your best,” Cohen recalled.

For the new study, Cohen and his colleagues zeroed in on one particularly problematic bit of phrasing at the start of the PHQ, where patients are asked how often they’ve been “bothered by” any of a list of symptoms.

In an experiment, the research team asked about 850 people to fill out a PHQ, which lists oversleeping as one of the symptoms.

Afterward, the researchers presented a hypothetical — imagine that you’d overslept every day for a week, but weren’t bothered by the oversleeping because you were on vacation.

Participants were asked to reconsider their earlier response to the oversleeping question based on that information.

"If you're reading the instructions to the letter, you would actually expect a 'not at all' there," Cohen said, because the patient was never bothered by oversleeping, even though they did it every day.

But results showed that the “bothered by” wording was not consistently taken into account by the participants, when they were asked the question a second time with the added context.

Only 38% correctly answered “not at all” when asked a second time about oversleeping, and only 17% indicated they would answer based on “bothered by” if they filled out a PHQ in the future.

The results show that the test isn’t accurately portraying what patients are experiencing, Cohen said.

"Most of the time when we use these questionnaires we want to know about symptoms of depression, so the 'bothered by' part really matters," he said.

"Think about the recent explosion of people using GLP-1 weight loss drugs,” Cohen said. “For someone who is on Ozempic, experiencing reduced appetite probably shouldn't be counted as an indicator of depression – that's the main reason they're taking the drug."

Given how widely the PHQ is used, these misperceptions and misunderstandings could add up to far-reaching problems, Cohen said.

"I struggle to imagine that it's a good thing to have some people answering one way, and some people answering the exact opposite way for the same experience," he said. "There's just no way that that can be a good thing – and in this paper, we show that it's happening and provide preliminary evidence of how that can be a problem."

Cohen said future research should focus on changing the language of the questions in ways that make them clearer to patients.

"If I want to know how frequently people are oversleeping, then just change the wording of the instructions and make it very clear that I'm just asking about the frequency of oversleeping," he said.

"Alternatively, if I want to avoid mischaracterizing things like intentional appetite reduction as a symptom of depression, I could change the wording to better emphasize the 'bothered by' component,” Cohen said. “Obviously, we'd want to do the studies that would show that that does solve some of these problems, but I would imagine that that would be a both straightforward and decently comprehensive fix."

More information

The American Psychological Association has more about the Patient Health Questionnaire.

SOURCE: University of Arizona, news release, Dec. 17, 2025