Ten things wrong with Google’s effort to help people suffering with depression

A number of websites are echoing a press release from Google about its intention to help people suffering from depression. There are lots of reasons to doubt the effort will accomplish much. Here are ten of them.

barnie shame on NAMI

 

CNNtech

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Excerpts

Google has a new feature designed to help people suffering from depression.

Users in the United States who search for “depression” or “clinical depression” will now be offered a questionnaire to test their depression levels and help determine whether they should seek professional help, Google said in a blog post.

Users who search for information on depression will be shown a box at the top of their screen encouraging them to “check if you’re clinically depressed.” The clinically validated test, called PHQ-9, asks about energy, appetite and concentration levels, among other things.

The initiative was developed in partnership with the National Alliance on Mental Illness (NAMI).

“The results of the PHQ-9 can help you have a more informed conversation with your doctor,” wrote Mary Giliberti, CEO of NAMI.

“We hope that by making this information available on Google, more people will become aware of depression and seek treatment to recover and improve their quality of life,” explained Giliberti.

Another website adds:

google now has

Excerpts

The Patient Health Questionnaire 9 (PHQ-9) is clinically approved “to test what your likely level of depression may be.” To further ensure that the information is accurate, Google has collaborated with the National Alliance on Mental Illness (NAMI).

Going by the statistics, the results show that those who have symptoms of depression go through an average of a 6-8 year delay before turning up for treatment. Awareness about depression can help users in identifying it and getting help faster.

The PHQ-9

 At the present time, Google will only present the PHQ-9 as a set of individual items appearing on mobile devices. However here is a paper version of the PHQ-9 with the full nine items.

phq9-depression-questionnaire-1-728

What’s not to like about this noble effort?

1.There is no evidence that screening itself improves depression outcomes on an individual or population basis. See our comprehensive review here

2.The PHQ-9 is an imperfect screening device that is insufficient by itself to arrive at a diagnosis.

3. Unfortunately, both primary care physicians and patients sometimes interpret PHQ-9 scores as a diagnosis. Physicians may even prescribe medication solely on the basis of the results of a screening instrument, rather than conducting a detailed probing of even if the patients understood what the questions were intended to assess.

4. A question about anhedonia, one of the two cardinal symptoms of depression is particularly difficult for laypersons to comprehend. “Little interest in pleasure in doing things.”  The question is intended to assess the cardinal symptom of depression anhedonia, which is not simply not feeling like the person wants to do what was once pleasurable, but lacking the capacity to experiencing pleasure.

Persons with physical complaints like headaches or gastrointestinal disturbance may endorse it because feeling ill is sufficient to discourage them from doing such things. That is not what is meant. Now think of a mother holding her new infant and being unable to feel the affection she knows she feels. That is anhedonia.

5. Most persons who score high on the scale won’t seek out a diagnosis from a professional. For many of these people, a diagnosis would not be warranted. The clinical condition would be ruled out with a structured interview.

6. However, filling out the questionnaire could be self-stigmatizing in that those with high scores are led to believe they are clinically depressed, when they are not. They feel badly about that but perhaps cannot access and do not actually want formal treatment. A common reason for declining treatment is persons feeling they can handle what is going on without formal treatment.

7. Despite the statement in the article, it is not necessarily bad that many patients who ultimately seek treatment for depression having experienced bouts of it one or more times before acting. Depression is not the kind of condition that treatment of one episode necessarily heads off later episodes. Early episodes, particularly in people drawn from the community, may be too mild or fleeting to benefit from treatment.

8. Studies find that many patients who screen positive are either already in treatment or they may have left treatment because they are dissatisfied with the benefits compared to the effort and cost.

9. The key issue in depression that would benefit from treatment nontheless going unaddressed is access to treatment that is affordable and consistent with patient preferences.

10. Finally, many of us find it annoying and intrusive to be asked by a search engine if we are clinically depressed on the basis of a search with the words “depression.”

So, basically screening is unlikely to improve the outcomes of depression in the community. It may lead to overtreatment and encouraging community right citing prequel to label themselves as clinically depressed when they are not, with the possibility of some self stigmatization.

Google would do well to provide an explanation of what depression is in terms understable to laypersons. Then use the power of the giant search engine to provide tailored information as to how diagnosis and treatment can be affordably obtained locally. This is preferable  to simply screening people and leaving them confused or misinformed as to what their scores mean. Tailored referral information might not accomplish much either, but ot would show more appreciation of how it is to get depressed persons in the community some relief and how such efforts can backfire.