Should Dr Google screen for depression?

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Web giant Google has reportedly rolled out a population screening program for clinical depression in the US

The National Alliance on Mental Illness (NAMI), a US-based mental health organisation, has partnered with Google to create a screening tool for clinical depression.

According to NAMI, when US consumers search for “clinical depression” on Google (on mobile), they will see a panel that will give them the option to tap “Check if You’re Clinically Depressed”.

The link will bring them to PHQ-9, a screening questionnaire to test what the consumer’s likely level of depression may be.

With suggestions that online screening will be beneficial—and others warning it may cause harm—the British Medical Journal has this week covered both sides of the debate.

Some medical researchers have expressed concern about the screening tool.

Simon Gilbody, professor of psychological medicine and health services research at the University of York in the UK, argues that the case for screening for depression “falls down on several key criteria”.

Professor Gilbody argues that:

  • False positive rates are high;
  • People with a positive result may have a range of disorders other than depression (including PTSD, personality difficulties, and bipolar disorder);
  • Screening programs will likely add to the upward trend in antidepressant prescriptions; and
  • Systematic review show that screening programs do not improve depression.

He also shares concerns that personal data generated by the depression screening program could be used by pharmaceutical companies to market antidepressants.

While Google has offered reassurance in this respect, Professor Gilbody says it hasn’t highlighted that the PHQ-9 test is copyrighted by Pfizer, and that NAMI is reported to derive much of its income from the drug industry.

“Finally there is a risk of harm. Depression should be diagnosed after a clinical assessment (including risk assessment) rather than a single PHQ-9 test. It is unlikely that it will improve population health and may in fact do harm,” he argues.

NAMI has defended its decision to roll out the online screening tool.

“Nearly a fifth of Americans experience clinical depression at some time. However, about half of these people do not receive any treatment, and the rest wait an average six to eight years,” says Ken Duckworth, NAMI medical director.

“Google offering the PHQ-9 is not meant to replace clinical screening; nor does it constitute a universal screening program,” he says.

“Instead, it is intended as widespread education to prompt informed conversations with clinical professionals and to suggest potentially helpful resources.”

Dr Duckworth adds that this is balanced against existing potential harms—Googling “depression tests” yields many different surveys, not all of which are clinically validated or beneficial.

Meanwhile, he says PHQ-9 is validated for use in primary care, based on the DSM-5 criteria for clinical depression.

Links to materials from NAMI and telephone helplines will accordingly be given with the Google screening test for people with higher scores.

Dr Duckworth suggests the idea could lead to further technological investments for depression in the future, including telemedicine, teletherapy, and online cognitive behaviour therapy.

What do you think about the idea? Should Google be screening for depression?

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