mental-health

name	mental-health
description	Comprehensive mental health monitoring with automatic cross-dimensional correlation analysis. Tracks mood, anxiety, stress using validated scales (PHQ-9, GAD-7, PSS). Provides crisis risk screening, CBT techniques, and automatically analyzes correlations with sleep, exercise, nutrition, and chronic conditions. Triggers on: mental health, mood, anxiety, stress, depression, feeling sad, worried, overwhelmed, panic, therapy, emotional, burnout.
allowed-tools	["bash","glob","read"]
version	1.0.0

Mental Health — Your Emotional Wellness Companion

Compassionate mental health monitoring with automatic correlation analysis to identify how sleep, exercise, nutrition, and physical health affect your emotional well-being.

Cross-Dimensional Correlation Analysis (Automatic)

This analysis runs automatically when mental health concerns are detected. No manual trigger needed.

Sleep ↔ Mental Health

Correlation	Typical r-value	Clinical Significance	Action
Sleep duration ↔ PHQ-9	-0.6 to -0.8	Strong negative	Each 1-hour increase → 0.5-1 point PHQ-9 reduction
Sleep quality ↔ GAD-7	-0.6 to -0.7	Strong negative	PSQI improvement → anxiety reduction
Sleep latency ↔ Next-day mood	0.5 to 0.6	Moderate positive	Longer latency → worse mood
REM sleep ↔ Emotional regulation	-0.5 to -0.6	Moderate negative	REM disruption → emotional dysregulation

Recommendations based on correlation:

• If r < -0.7: Sleep is primary driver → Prioritize sleep intervention (CBT-I, sleep hygiene)
• If r = -0.4 to -0.7: Moderate influence → Address sleep as part of comprehensive plan
• If r > -0.4: Weak influence → Focus on other factors (exercise, therapy, medication)

Exercise ↔ Mental Health

Correlation	Typical r-value	Clinical Significance	Action
Exercise frequency ↔ PHQ-9	-0.5 to -0.7	Strong negative	Each session/week → 1-2 point PHQ-9 reduction
Exercise intensity ↔ Anxiety	-0.4 to -0.6	Moderate negative	Moderate intensity optimal
Outdoor exercise ↔ Mood	-0.5 to -0.6	Moderate negative	Nature exposure amplifies benefit
Exercise consistency ↔ Stability	-0.6 to -0.7	Strong negative	Regular schedule → mood stability

Exercise Prescription for Mental Health:

• Depression: Aerobic exercise, 3-5 sessions/week, 30-45 min, moderate intensity (60-75% HRmax)
• Anxiety: Mind-body exercises (yoga, tai chi), 2-3 sessions/week + walking daily
• Stress: Any enjoyable activity, focus on consistency over intensity

Nutrition ↔ Mental Health

Nutrient	Correlation	Mechanism	Recommendation
Omega-3 (EPA+DHA)	r = -0.4 to -0.6	Anti-inflammatory, neurotransmitter function	1-2g daily (fish, supplement)
Vitamin D	r = -0.4 to -0.5	Neuroprotection, serotonin synthesis	1000-2000 IU daily, sun exposure
B vitamins (B6, B9, B12)	r = -0.3 to -0.5	Methylation, neurotransmitter synthesis	Leafy greens, legumes, animal products
Magnesium	r = -0.4 to -0.5	GABA activation, muscle relaxation	300-400 mg daily (nuts, seeds, greens)
Zinc	r = -0.3 to -0.4	Neurotransmitter modulation	10-15 mg daily (meat, shellfish, legumes)
Caffeine	r = 0.4 to 0.6 (anxiety)	Adenosine blockade, cortisol elevation	Limit to ≤400mg/day, avoid after 2 PM
Sugar/Refined carbs	r = 0.4 to 0.5 (mood swings)	Blood glucose fluctuations	Choose complex carbs, fiber
Alcohol	r = 0.5 to 0.6 (depression)	GABA/glutamate disruption, sleep fragmentation	Limit to ≤1 drink/day, avoid when depressed

Chronic Conditions ↔ Mental Health

Condition	Correlation	Bidirectional?	Management Implication
Chronic pain	r = 0.6 to 0.8	Yes	Treat both simultaneously
Diabetes	r = 0.4 to 0.6	Yes	Depression screening essential
Hypertension	r = 0.3 to 0.5	Partial	Stress management helps both
Thyroid disorders	r = 0.5 to 0.7	Yes (thyroid → mood)	Rule out thyroid dysfunction
IBS/Gut issues	r = 0.5 to 0.6	Yes	Gut-brain axis, consider probiotics
Autoimmune conditions	r = 0.4 to 0.6	Partial	Inflammation link, anti-inflammatory diet

Medication Side Effects ↔ Mental Health

Medication Class	Potential Effect	Monitoring
Corticosteroids	Mood swings, anxiety, insomnia	Monitor mood during taper
Beta-blockers	Fatigue, depression (controversial)	Assess if temporal relationship
Hormonal contraceptives	Mood changes (individual)	Track cycle + mood
Stimulants	Anxiety, sleep disruption	Dose timing, consider adjustment
Statins	Muscle pain → secondary depression	Address pain, consider alternative

Integrated Intervention Framework

When Sleep is Primary Driver (r < -0.7 with sleep)

Week 1-2: Sleep Foundation

• Sleep restriction therapy (limit time in bed to actual sleep time)
• Stimulus control (bed only for sleep)
• Consistent wake time (anchor point)

Week 3-4: Sleep Optimization

• Pre-sleep routine (60-min wind-down)
• Light exposure management (morning light, evening dim)
• Caffeine/alcohol timing

Expected Outcome: 2-4 point PHQ-9 reduction with 1-2 hour sleep improvement

When Exercise is Primary Driver (r < -0.7 with exercise)

Week 1-2: Activation

• Behavioral activation (schedule 1 pleasant activity/day)
• 10-min walk daily (minimum viable dose)
• Focus on enjoyment, not performance

Week 3-4: Building

• Increase to 30 min, 3x/week
• Add social component (walk with friend)
• Track mood before/after each session

Week 5-8: Consolidation

• 150 min/week moderate exercise
• Add resistance training 2x/week
• Maintain consistency over intensity

Expected Outcome: 3-5 point PHQ-9 reduction with consistent exercise

When Nutrition is Primary Driver (r > 0.5 with dietary factors)

Week 1-2: Elimination

• Remove caffeine (if anxiety) or alcohol (if depression)
• Reduce added sugars
• Regular meal timing

Week 3-4: Addition

• Omega-3 supplementation (1-2g EPA+DHA)
• Increase vegetables (5 servings/day)
• Protein at each meal (satiety, neurotransmitter precursors)

Week 5-8: Optimization

• Mediterranean diet pattern
• Mindful eating practices
• Address emotional eating triggers

Expected Outcome: 2-3 point PHQ-9 reduction with dietary improvement

When Chronic Condition is Primary Driver

Integrated Approach:

1. Optimize physical condition management (medication adherence, lifestyle)
2. Address condition-specific mental health impacts (pain → depression, diabetes distress)
3. Coordinate care between PCP, specialists, and mental health provider
4. Consider condition-specific interventions (CBT for chronic pain, diabetes education)

Expected Outcome: Variable; focus on quality of life, acceptance, coping

Enhanced Output Format

# Mental Health Report — March 20, 2026

## 🚨 Crisis Screening
**Risk Level**: 🟢 Low (Score: 3/20)
- ✅ No suicidal ideation (PHQ-9 Item 9 = 0)
- ✅ Symptom trend: Improving
- ✅ Social connection: Good

---

## 📊 Assessment Results

### PHQ-9 (Depression)
| Date | Score | Severity | Trend |
|------|-------|----------|-------|
| Mar 20 | 6 | Mild | ↓ Improving |
| Feb 20 | 9 | Mild | → Stable |
| Jan 20 | 12 | Moderate | ↑ Worsening |

### GAD-7 (Anxiety)
| Date | Score | Severity |
|------|-------|----------|
| Mar 20 | 5 | Mild |
| Feb 20 | 8 | Mild |

---

## 🔗 Automatic Correlation Analysis

### Key Finding: Sleep Duration ↔ Depression
**Correlation**: r = -0.78 (Strong Negative)
**Interpretation**: When you sleep <7 hours, PHQ-9 averages 4 points higher
**Action Plan**:
- Priority #1: Increase sleep to 7-8 hours/night
- Expected impact: 3-4 point PHQ-9 reduction
- Strategy: CBT-I techniques, consistent wake time, no screens after 9 PM

### Secondary Finding: Exercise ↔ Anxiety
**Correlation**: r = -0.52 (Moderate Negative)
**Interpretation**: Exercise days show 30% lower GAD-7 scores
**Action Plan**:
- Maintain 3x/week exercise routine
- Add 10-min walk on non-exercise days
- Track mood before/after each session

### Nutrition Factor: Caffeine ↔ Sleep
**Correlation**: r = 0.61 (Moderate Positive)
**Interpretation**: Afternoon caffeine → 45 min longer sleep latency
**Action Plan**:
- No caffeine after 12 PM (moved from 2 PM)
- Switch to decaf/herbal tea after noon
- Reassess in 2 weeks

---

## 📋 Integrated Treatment Plan

### This Week
- [ ] Sleep: Consistent wake time at 7 AM (±30 min)
- [ ] Exercise: 3 walks (30 min each)
- [ ] Nutrition: No caffeine after 12 PM
- [ ] Therapy: Complete 3 thought records

### Next 2 Weeks
- [ ] Sleep: Implement pre-sleep routine (60 min, no screens)
- [ ] Exercise: Add 1 yoga session
- [ ] Nutrition: Omega-3 supplementation (1g EPA+DHA)

### Follow-Up
- PHQ-9/GAD-7 reassessment: April 3, 2026
- If PHQ-9 ≥10 or GAD-7 ≥10: Consider therapy referral

---

## ⚠️ When to Seek Professional Help

**Immediate (24 hours):**
- PHQ-9 Item 9 ≥1 (suicidal thoughts)
- Risk score ≥10
- Unable to function (work, self-care)

**Soon (1-2 weeks):**
- PHQ-9 ≥15 or GAD-7 ≥15
- Symptoms worsening despite self-help
- Significant impairment in daily life

**Routine (1 month):**
- PHQ-9 10-14 or GAD-7 10-14
- Interested in therapy or medication
- Recurrent episodes

---

## 📚 Resources

**Self-Help:**
- MoodGYM (online CBT program)
- Headspace/Calm (meditation apps)
- CBT Thought Diary (app)

**Crisis Support:**
- National Suicide Prevention Lifeline: 988 (US)
- Crisis Text Line: Text HOME to 741741
- Local emergency: 911

---

**Disclaimer**: This assessment is for informational purposes only and does not constitute mental health diagnosis or treatment. Always consult qualified mental health professionals for diagnosis and treatment. In case of crisis, contact emergency services immediately.

---

Safety Protocols

Mandatory Crisis Screening

Every session must assess:

1. PHQ-9 Item 9 (suicidal ideation)
2. Recent self-harm behavior
3. Specific suicide plan
4. Access to lethal means
5. Protective factors (family, beliefs, future orientation)

Referral Thresholds

Situation	Action	Timeline
Active suicidal ideation with plan	Emergency evaluation	Immediate
PHQ-9 ≥20 or GAD-7 ≥20	Psychiatric evaluation	Within 1 week
PHQ-9 15-19 or GAD-7 15-19	Therapy + consider medication	Within 2 weeks
PHQ-9 10-14 or GAD-7 10-14	Therapy recommended	Within 1 month
No improvement after 4 weeks self-help	Professional consultation	Reassess approach

Documentation Requirements

Every session documents:

• PHQ-9 and GAD-7 scores
• Risk assessment level
• Safety plan (if elevated risk)
• Follow-up plan
• Referrals made (if any)

---

Version: v2.0 (with automatic correlation analysis) Created: March 2026 Maintainer: Family Doctor Team

PHQ-9 (Depression Screening)

Score	Severity	Action
0-4	None-minimal	Self-care
5-9	Mild	Lifestyle changes, monitoring
10-14	Moderate	Consider therapy
15-19	Moderately severe	Therapy recommended
20-27	Severe	Seek professional help

Item 9 (Suicidal Ideation): Score ≥1 requires immediate attention.

GAD-7 (Anxiety Screening)

Score	Severity
0-4	Minimal
5-9	Mild
10-14	Moderate
15-21	Severe

PSS-10 (Perceived Stress)

Score	Level
0-13	Low
14-26	Moderate
27-40	High

Crisis Risk Assessment

Risk Factors (0-20 Scale)

• PHQ-9 Item 9 ≥2: +10 points (immediate risk)
• Symptom deterioration ≥5 pts/month: +5
• High negative emotions (>70%): +3
• Major life stressor: +2
• Social isolation: +2
• Substance use increase: +3
• Hopelessness: +5

Risk Levels

Score	Level	Action
≥10	🔴 High	24-hour professional help
5-9	🟡 Moderate	48-hour consultation
<5	🟢 Low	Continue monitoring

CBT Techniques

Thought Records

1. Situation: What happened?
2. Automatic thoughts: What went through my mind?
3. Emotions: How did I feel? (0-100%)
4. Evidence for: Facts supporting thought
5. Evidence against: Facts contradicting thought
6. Alternative thought: Balanced perspective
7. Re-rate emotions: After reconsideration

Behavioral Activation

• Schedule pleasant activities
• Activity monitoring
• Graded task assignments
• Social engagement

Anxiety Management

• Deep breathing (4-7-8 technique)
• Progressive muscle relaxation
• Grounding techniques (5-4-3-2-1 senses)
• Worry time scheduling

Output Example

# Mental Health Report — March 20, 2026

## 🚨 Crisis Screening
**Risk Level**: 🟢 Low (Score: 3/20)
- ✅ No suicidal ideation (PHQ-9 Item 9 = 0)
- ✅ Symptom trend: Improving
- ✅ Social connection: Good

---

## 📊 Assessment Results

### PHQ-9 (Depression)
| Date | Score | Severity |
|------|-------|----------|
| Mar 20 | 6 | Mild |
| Feb 20 | 9 | Mild |
| Jan 20 | 12 | Moderate |

**Trend**: ⬇️ Improving (-6 points in 2 months) ✓

### GAD-7 (Anxiety)
| Date | Score | Severity |
|------|-------|----------|
| Mar 20 | 8 | Mild |
| Feb 20 | 11 | Moderate |

**Trend**: ⬇️ Improving (-3 points) ✓

### PSS-10 (Stress)
Score: 16/40 (Moderate stress)
Primary stressors: Work demands, financial concerns

---

## 🎭 Mood Pattern Analysis

### This Week
| Day | Mood (1-10) | Notes |
|-----|-------------|-------|
| Mon | 6 | Work stress |
| Tue | 7 | Good sleep |
| Wed | 5 | Deadline pressure |
| Thu | 7 | Exercise |
| Fri | 8 | Weekend anticipation |
| Sat | 8 | Social activity |
| Sun | 6 | Sunday blues |

**Average**: 6.7/10 | **Trend**: Stable

### Correlations Detected
- **Sleep ↔ Mood**: r = +0.68 (good sleep = better mood)
- **Exercise ↔ Mood**: r = +0.72 (strong positive)
- **Work stress ↔ Anxiety**: r = +0.55 (moderate)

---

## 💡 Recommendations

### For Depression Symptoms (PHQ-9 = 6)
1. Continue behavioral activation (3 activities/week)
2. Maintain exercise routine (proven mood booster)
3. Practice thought records for negative thinking
4. Consider therapy if score >10 or persists >2 weeks

### For Anxiety (GAD-7 = 8)
1. Daily deep breathing practice (10 min)
2. Worry time: 15 min at 6 PM (contain worry)
3. Limit caffeine to <200mg/day
4. Progressive muscle relaxation before bed

### For Stress (PSS = 16)
1. Work boundaries: No email after 7 PM
2. Mindfulness: 10-min daily practice
3. Social support: 2 social activities/week
4. Time management: Prioritize, delegate

---

## 📋 Action Plan

### Today
- [ ] Complete one pleasant activity
- [ ] Practice 4-7-8 breathing (3 cycles)

### This Week
- [ ] Daily mood tracking
- [ ] 3 exercise sessions
- [ ] Connect with friend/family

### Professional Support
- If PHQ-9 >10 or GAD-7 >10 for 2+ weeks: Consider therapy
- If suicidal thoughts: Call crisis line immediately
- If functioning impaired: Seek psychiatric consultation

---

## 🆘 Crisis Resources

**Emergency** (24/7):
- US: 988 (Suicide & Crisis Lifeline)
- UK: Samaritans at 116 123
- International: Find at findahelpline.com

**Remember**: Mental health challenges are common and treatable. You don't have to face them alone.