<ObservationDefinition xmlns="http://hl7.org/fhir">
  <id value="mii-obsdef-pro-depression-t-score" />
  <meta>
    <profile value="https://www.medizininformatik-initiative.de/fhir/ext/modul-pro/StructureDefinition/mii-pr-pro-score-blueprint|2026.5.0" />
  </meta>
  <extension url="http://hl7.org/fhir/StructureDefinition/artifact-version">
    <valueString value="2026.5.0" />
  </extension>
  <extension url="http://hl7.org/fhir/StructureDefinition/cqf-citation">
    <valueString value="Riazy L, Grote M, Liegl G, Rose M, Fischer F. Cross-Sectional Reference Data From 29 European Countries for 6 Frequently Used Depression Measures. JAMA Network Open. 2025;8(6):e2517394" />
  </extension>
  <category>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/observation-category" />
      <code value="survey" />
    </coding>
  </category>
  <code>
    <coding>
      <system value="http://loinc.org" />
      <code value="77861-3" />
      <display value="PROMIS emotional distress - depression - version 1.0 Tscore" />
    </coding>
    <coding>
      <system value="https://www.medizininformatik-initiative.de/fhir/ext/modul-pro/CodeSystem/mii-cs-pro-score-catalogue" />
      <code value="promis-depression" />
      <display value="PROMIS Depression Score" />
    </coding>
  </code>
  <permittedDataType value="Quantity" />
  <multipleResultsAllowed value="false" />
  <method>
    <text value="PROMIS Depression T-score metric derived from European Health Interview Survey (EHIS) wave 3 cross-cultural validation study" />
  </method>
  <quantitativeDetails>
    <unit>
      <coding>
        <system value="http://unitsofmeasure.org" />
        <code value="{score}" />
        <display value="{score}" />
      </coding>
    </unit>
  </quantitativeDetails>
  <qualifiedInterval>
    <category value="reference" />
    <range>
      <extension url="https://www.medizininformatik-initiative.de/fhir/ext/modul-pro/StructureDefinition/mii-ex-pro-score-score-health-correlation">
        <valueCodeableConcept>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation" />
            <code value="decrease" />
          </coding>
          <text value="Higher scores indicate worse health (more depression symptoms)" />
        </valueCodeableConcept>
      </extension>
      <low>
        <value value="41.8" />
      </low>
      <high>
        <value value="51.5" />
      </high>
    </range>
    <context>
      <text value="German general population - EHIS wave 3 (n=22,996): Mean 46.5 (SD 7.7), Median 45.5" />
    </context>
    <appliesTo>
      <coding>
        <system value="http://loinc.org" />
        <code value="LA6112-2" />
        <display value="General population" />
      </coding>
      <text value="German general population - EHIS wave 3 (n=22,996)" />
    </appliesTo>
  </qualifiedInterval>
  <qualifiedInterval>
    <category value="reference" />
    <range>
      <extension url="https://www.medizininformatik-initiative.de/fhir/ext/modul-pro/StructureDefinition/mii-ex-pro-score-score-health-correlation">
        <valueCodeableConcept>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation" />
            <code value="decrease" />
          </coding>
          <text value="Higher scores indicate worse health (more depression symptoms)" />
        </valueCodeableConcept>
      </extension>
      <low>
        <value value="38.06" />
      </low>
      <high>
        <value value="50.4" />
      </high>
    </range>
    <context>
      <text value="European male population - EHIS wave 3 (29 countries): Median 44.11" />
    </context>
    <appliesTo>
      <coding>
        <system value="http://loinc.org" />
        <code value="LA6112-2" />
        <display value="General population" />
      </coding>
      <text value="European male population - EHIS wave 3 (29 countries)" />
    </appliesTo>
    <appliesTo>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v3-AdministrativeGender" />
        <code value="M" />
        <display value="Male" />
      </coding>
    </appliesTo>
  </qualifiedInterval>
  <qualifiedInterval>
    <category value="reference" />
    <range>
      <extension url="https://www.medizininformatik-initiative.de/fhir/ext/modul-pro/StructureDefinition/mii-ex-pro-score-score-health-correlation">
        <valueCodeableConcept>
          <coding>
            <system value="http://terminology.hl7.org/CodeSystem/measure-improvement-notation" />
            <code value="decrease" />
          </coding>
          <text value="Higher scores indicate worse health (more depression symptoms)" />
        </valueCodeableConcept>
      </extension>
      <low>
        <value value="40" />
      </low>
      <high>
        <value value="52.76" />
      </high>
    </range>
    <context>
      <text value="European female population - EHIS wave 3 (29 countries): Median 46.37" />
    </context>
    <appliesTo>
      <coding>
        <system value="http://loinc.org" />
        <code value="LA6112-2" />
        <display value="General population" />
      </coding>
      <text value="European female population - EHIS wave 3 (29 countries)" />
    </appliesTo>
    <appliesTo>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v3-AdministrativeGender" />
        <code value="F" />
        <display value="Female" />
      </coding>
    </appliesTo>
  </qualifiedInterval>
  <qualifiedInterval>
    <category value="reference" />
    <range>
      <low>
        <value value="39.11" />
      </low>
      <high>
        <value value="51.68" />
      </high>
    </range>
    <context>
      <text value="Overall European population median (IQR) - EHIS wave 3, 29 countries (n=287,530)" />
    </context>
    <appliesTo>
      <coding>
        <system value="http://loinc.org" />
        <code value="LA6112-2" />
        <display value="General population" />
      </coding>
      <text value="Overall European population - EHIS wave 3, 29 countries (n=287,530)" />
    </appliesTo>
  </qualifiedInterval>
</ObservationDefinition>