Google’s screening tool that enables people to check online whether they are clinically depressed could do more harm than good, one expert has warned.
Last month, the tech giant released a self-assessment quiz, called the Patient Health Questionnaire-9 (PHQ-9), which pops up as a result for the search query ‘Am I depressed?’ on a computer or cell phone.
Google developed its test in partnership with the National Alliance on Mental Illness (NAMI) but one professor claims that the quiz could just lead to over-treatment of depression amid the US’s opioid epidemic.
He warns the tool’s development was funded by major drug company Pfizer, which profits from the sale of antidepressants.
When you type ‘depression’ into Google on your computer or mobile phone, it gives you the option to take its new screening test
Google and NAMI both stressed that the results of their test are not an actual diagnosis.
The quiz asks questions about how frequently the respondent feels down, what their energy levels, sleeping and eating habits are like, and if they have had recent thoughts of suicide.
It returns a numeric score and is meant to help users determine when to seek help, and to provide some basic information they can take to their health care professionals for reference.
But Simon Gilbody, professor of psychological medicine at the University of York, warned that the test has a high likelihood of returning false positives.
Writing in the British Medical Journal (BMJ), he claimed that many of the answers the test would identify as warning signs were actually ‘transient psychological distress, which will remit without treatment.’
He also expressed concern that the test could misidentify other disorders or mental health issues as depression.
This tool asks questions such as the frequency with which people feel down or depressed, energy levels, sleeping patterns, appetite, level of interest in things or suicidal thoughts.
It takes an average of six years for a person to be diagnosed with depression. One of the goals of the test is to shorten that gap.
Google and NAMI have stressed that the test should not replace diagnosis by a qualified mental health professional, and argue it will help people seek help more quickly.
Google has also said users will not have their answers logged by the company and will not be targeted by advertising related to depression.
Gilbody warns that depression screening is generally inadequate, even in most health systems – let alone online – and are not recommended in the UK.
However, less than a week ago, the US Preventative Services Task Force (USPSTF) published a final recommendation that clinicians screen all adults for depression.
‘The USPSTF found convincing evidence that screening improves the accurate identification of adult patients with depression in primary care settings, including pregnant and postpartum women,’ the recommendation says.
Google is driving people quicker down the path to big pharma
David Gilbert, director of InHealth Associates
But it does caution that screening should only be done ‘with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.’
In the BMJ’s ‘Head to Head’ section, another expert refuted many of Gilbody’s concerns.
He argued that in an age where blood pressure and blood sugar levels can be tested at home, it’s high time we have tools to gauge our mental health too. Duckworth saw the PHQ-9 score as a good potential basis for standardizing metrics of mental health care.
Since Google does not recommend a treatment when the test is completed, and the score is not a formal diagnosis, Duckworth dismissed these concerns.
Instead, the test ‘is intended as widespread education to prompt informed conversations with clinical professionals to suggest potentially helpful resources,’he wrote.
Can the test and its makers be trusted?
Gilford claims that ‘it is likely that screening programs will add to the upward trend in antidepressant prescriptions (which have the greatest year on year increase of any drug class).’
Gilford is undoubtedly not alone in his concern that antidepressants are over prescribed.
A number of common antidepressants, including Xanax, Restoril, and diazepam, 9formerly known as Valium) are benzodiazepines, a family of drugs that greatly increase the risk of death when taken with opioids.
Xanax is made by Pfizer, who Gilbody claims was involved in the development of the tool.
David Gilbert, director of InHealth Associates echoed concerns about Pfizer’s involvement.
‘Google is driving people quicker down the path to big pharma. Remember,Pfizer funded the development of the tool,’ he wrote in Head to Head.
In fact, Pfizer did own the copyright to the PHQ-9 tool, but this is no longer the case, according to Patient.info.
Gilford expressed concern about privacy and misuse of data from the test, as have a few others.
‘Historically, the boundaries between pharmaceutical advertising and patient information are also blurred by the presence of online disease awareness campaigns sponsored by industry,’ he wrote.
Duckworth, on the other hand, felt confident in Google’s promise that no user data from the test would be kept or used for targeted marketing.