If you’ve ever sat in a GP’s office and told them you haven’t been able to shower for weeks without crouching down and crying, they will have given you The Depression Quiz, otherwise known as the PHQ-9 Patient Health Questionnaire, or a variant on that. If you’ve felt too depressed to pull yourself out of bed, you might have taken The Quiz online. Either way, chances are it told you that you are utterly, totally, miserably depressed.
Now, campaigners are calling bullshit on this GP staple, claiming that depression is being over diagnosed because GPs are too reliant on the questionnaire – noting that it was designed by a pharmaceutical company which also manufacturers psychiatric drugs.
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The nine question form sets the threshold “far too low” and results in patients being wrongly diagnosed and medicated, according to an expert at the Council for Evidence-Based Psychiatry. The PHQ-9 Patient Health Questionnaire was developed by academics funded by pharmaceutical company Pfizer. Critics have also warned that the similar quiz they use for detecting anxiety – also Pfizer-funded – sets the bar for diagnosis too low.
Dr James Davies, researcher at the University of Roehampton and co-founder of the Council for Evidence-Based Psychiatry, told The Telegraph: “GPs are very busy and they often don’t have time to do a full interview. It’s about getting people in and out of the door in 10 minutes. These forms have a very low criteria for anxiety and depression.”
It asks questions like, “Trouble falling or staying asleep, or sleeping too much?”, “Feeling tired or having little energy?” and “Poor appetite or overeating?” A few of us in the office took the test – which you can take right here – and everyone bar one got mild depression. A couple of these respondents have never been diagnosed with depression, or really gone through any bouts of what they thought of as depression. I personally got “moderately severe depression”, but, stunningly, don’t have depression right now.
I think it’s safe to say all of us eat terribly, drink too much, don’t exercise enough, are confronted with the news and current affairs every day and work reasonably hard. If I have trouble sleeping “on several days” or “nearly every day” that bumps up my score significantly. And herein lies the problem: all of the indicators are symptoms of a modern lifestyle as well as signals of depression.
Professor Sir Simon Wessely, President of the Royal College of Psychiatrists, said PHQ-9 are “screening tools, not diagnostic criteria”, which suggests they work only as an indicator. Other defenders of the questionnaire say that GPs use face-to-face chats to diagnose, too.
However, critics, such as the Council for Evidence-Based Psychiatry, are pointing out that a reliance on these questionnaires is becoming commonplace because GPs don’t have enough time to do proper interviews. The Tories have promised 3,000 extra mental health therapists to work in GP practices by 2020, which would certainly help, but considering the Tories’ healthcare pledges frequently amount to nothing, I wouldn’t hold your breath.
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