Should Google offer an online screening test for depression?
BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j4144 (Published 13 September 2017) Cite this as: BMJ 2017;358:j4144
All rapid responses
The simple screening tool for depression being offered by Google is likely to pick up large numbers of users with transient psychological distress and there are more sophisticated tools being developed such as Historian, a freely available app on the app store, developed by the author (without any external funding or commercial ties). Historian aims to take a comprehensive psychiatric history and self-report mental state and offers an analysis and diagnoses based on the indidual's selections. Digital health innovation offers many challenges. In the arena of mobile apps, the speed at which developers need to showcase their products in order to maintain pace with the competition and with technological advances remain a significant challenge to both developers and to research communities in providing an evidence base for products.
Competing interests: No competing interests
If online screening with the PHQ-9 test detects depressive traits, patients should be reminded that CBT or Behavioural Activation effectively treat clinical depression.
A meta-analysis published in the British Journal of Psychiatry has found that even patients with the most severe depression can expect to get as much benefit from cognitive behavioural therapy (CBT) as those with less severe symptoms. [1]
Even junior MHWs, trained for only 5 days, were able to deliver Behavioural Activation sessions against Depression, with equally effective outcomes, compared to CBT or second generation antidepressant pharmacotherapies, without side effects. [2][3]
Google (Alphabet Inc) could subsequently offer free peer-reviewed online computerized CBT AI sessions.
References
[1] http://bjp.rcpsych.org/content/210/3/190.long
[2] http://www.bmj.com/content/356/bmj.j914
[3] http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31140-0/fulltext
Competing interests: No competing interests
Re: Should Google offer an online screening test for depression?
As the website Patient info points out
PHQ9 " is not a screening tool for depression but it is used to monitor the severity of depression and response to treatment. However, it can be used to make a tentative diagnosis of depression in at-risk populations - eg, those with coronary heart disease or after stroke"...( see https://patient.info/doctor/patient-health-questionnaire-phq-9) .Therefore, to use it as an online screening tool is highly inappropriate.
It is also the case that such screening can be totally inaccurate. Positive responses suggesting depression can be the result of someone suffering from hypothyroidism ( who may well have less energy, be gaining weight and feeling bad about themselves as a result), anaemia or other chronic undiagnosed disease. The potential for harm through overdiagnosis or wrong diagnosis is inevitable.
The possibility of inappropriate direct to patient drug advertising via Google is also particularly worrying. As Google uses algorithms related to searches done, could we see unintended consequences such as highlighted links to suicide websites too?
Screening is seen as a "no brainer" by many, with little appreciation of the limitations and harms possible. All adverts for screening come with disclaimers explaining how do or do not meet Wilson and Jugners criteria for an effective screening programme? (http://apps.who.int/iris/bitstream/10665/37650/17/WHO_PHP_34.pdf)
Competing interests: No competing interests