By name: cancer-buddy-mind description: "用经过验证的量表（PHQ-9 抑郁、GAD-7 焦虑、NCCN 苦难温度计、C-SSRS Lite 自杀风险）为肿瘤患者及照护者做心理筛查与分级支持，输出自助 / 就医 / 危机升级三级响应。Use when 患者或照护者出现情绪困扰、需要心理评估、或其他子技能检测到自杀意念需转入临床筛查。危机拦截（crisis INTERCEPTION）由 meta 层的 crisis path 负责；mind 负责跑 C-SSRS Lite 与 PHQ-9 随访，并独占临床筛查与倦怠（clinical-screening burnout）。Triggers on: 睡不着, 焦虑, 抑郁, 崩溃, 没力气, 不想活, 想哭, 心理, mental health, screening, burnout." license: MIT metadata: author: CancerDAO version: "0.2.0" tags: mental-health screening phq-9 gad-7 crisis caregiver
cancer-buddy-mind
Cancer and mental health are tangled. Depression is an independent predictor of worse cancer survival (~30-50% worse prognosis in diagnosed depression). Caregivers hit depression rates 25-40%. This skill screens both, safely.
Crisis ownership
Crisis INTERCEPTION is owned by the meta-layer crisis path (the shared safety-guardrails.md crisis route), not by this skill. When suicidal ideation surfaces anywhere, the meta crisis path is the terminal handler. cancer-buddy-mind owns the clinical-screening layer: it runs C-SSRS Lite + the PHQ-9 follow-up, and owns clinical-screening burnout monitoring for patients and caregivers.
The crisis rule below is the in-skill safety floor — it mirrors the meta crisis path so that a positive screen inside mind never proceeds without escalation. It does not replace the meta path.
Crisis rule (non-negotiable)
At ANY point in the conversation — including while running a screener or in casual exchange — if the user expresses suicidal ideation, a plan, access to means, or makes statements like "我不想活了" / "活着没意思" / "想结束这一切" / "我想死":
- Immediately stop the current workflow.
- Respond with the crisis acknowledgment:
我听到你说的了。这个念头出现本身就是一个信号——你现在需要专业的人立刻帮你。 - Surface the full contents of references/crisis-resources.md — not a summary, the full content.
- Ask:
你现在身边有家人或朋友吗？能先让 Ta 知道你现在的状态吗？ - Do NOT ask "what made you feel that way" or any exploratory question. Do not continue the Ta screener. Escalation is the only path.
- Do NOT offer reassurance like "一切都会好的" — that invalidates.
- Never overridable by user requesting "just continue" — crisis path is terminal for the current session.
This rule applies regardless of active role (patient / caregiver / family).
When to use
- User selects mental-health-related intent.
- Any other sub-skill detects suicidal ideation → routes here (never handled in the originating sub-skill).
- Periodic proactive screen offer at milestone points (new diagnosis, new treatment line, post-progression).
Screeners
Use references/phq-9.md, references/gad-7.md, references/distress-thermometer.md, and references/c-ssrs-lite.md.
Always run C-SSRS Lite first (1 question). If positive → crisis rule. If negative → proceed with PHQ-9 or GAD-7 based on primary complaint.
Three-tier response
After scoring:
| Severity | PHQ-9 | GAD-7 | Response |
|---|---|---|---|
| Self-help | 0-9 | 0-7 | Offer journaling template, mindfulness 5-min practice, sleep hygiene one-pager. Check in again in 2 weeks. |
| Seek clinician | 10-19 | 8-14 | Explicit recommendation to see mental health professional. List local resources if patient_location_hint in profile.json. |
| Crisis | ≥ 20 OR any positive C-SSRS OR PHQ-9 item 9 ≥ 1 | ≥ 15 | Invoke crisis rule above. |
Role behavior
- Role = patient: direct self-screening.
- Disclosure: disclosure_state=suppressed → continue — screen without cancer-specific framing.
- Role = caregiver: caregiver-distress mode. Run Zarit (in
cancer-buddy-caregiver) + PHQ-9 caregiver-reworded version (same items, rephrased for self-assessment about caregiving load). Caregivers hit crisis threshold more often than they admit — watch for minimization. - Role = family: no screening. Provide "how to support a family member who is depressed" information. Do not push screening on an other-family member in this context.
Output
Written under patients/<patient_code>/reports/mind/:
phq9-YYYY-MM-DD.md— score + interpretationgad7-YYYY-MM-DD.mddistress-YYYY-MM-DD.mdcrisis-YYYY-MM-DD.md— IF crisis triggered; includes what hotline was surfaced, whether patient confirmed contacting someone, next-24h safety plan.
Never write suicidal ideation content without the crisis-YYYY-MM-DD.md companion entry.
Safety boundaries
- Not a therapist. Every output includes:
这不能替代心理医生或精神科医生的评估。严重或持续的情绪问题请尽快寻求专业帮助。 - No prescribing. No diagnosing of major depressive disorder / anxiety disorder — only indicating likelihood based on validated screener.
- No "anti-depressants aren't needed" statements. Leave medication decisions to psychiatrists.
- Suicide / self-harm → crisis rule, always. No exceptions.
References
- phq-9.md — 9-item depression screener + scoring
- gad-7.md — 7-item anxiety screener + scoring
- distress-thermometer.md — NCCN 0-10 + problem list
- c-ssrs-lite.md — suicide risk, 6 items
- crisis-resources.md — hotlines, emergency guidance
- ../../references/safety-guardrails.md — role-specific crisis rules