StayOnTop: Depression

If you search Google for “depression test”, you will get about 460,000 results: most of them brief online questionnaires that are supposed to help you determine if you are suffering from depression. If you omit the quote marks around “depression test”, Google will even spew out 192,000,000 results.

    Well, you saw my title, did you? No need to beat about the bush here. In nearly all cases, these online self-assessment depression tests are totally useless. Sometimes, they even do more bad than good. Let me explain.

    But before getting to those tests themselves, let’s ask ourselves why – apparently – they are so popular. Why would you want to take some online test to find out if you really depressed? Obviously, the fact itself that you want to test your mood for “depression”, already indicates that something feels wrong. Otherwise – if you felt just fine – why would you want to try one of those depression tests?

    So it looks like people are flocking to those test pages not to find out whether they feel somewhat depressed (they already know), but rather to find out if this depressed mood is Really Serious. They want to know if their problems deserve the Official Badge Of Serious Depression. They want such a test either to confirm “Yes indeed, we have to label you as an Official Case of Depression” or they want the test to tell them “Oh well, it’s not as bad as you thought, you don’t formally qualify”. Both outcomes are not only dubious, but will help you no further. Of course some test results may also scale you, say, 3 on a 1-to-5 depression scale. Would that help you in any way?

    Most of these thousands of online depression tests are more or less identical. The free tests are usually based on a standard pattern; most of them are an abridged version of the antiquated 1983 Wakefield Questionnaire. In many other cases, sites present a somewhat more modern depression question list that was put together with sponsoring by Pfizer (the pharmaceutic industry). All these lists pretend they can tell you if you are really depressed by your answering just a simple list of 15 to 20 questions; there are even many tests online that claim they can give you an outcome based on only 10 answers.

To be fair, I must say there are also depression tests of somewhat higher quality online: those may have over a 100 questions, and more often use not a simple list but a tree-pattern setup, meaning that your answer to one question determines what questions you will get next. But usually these more complex online tests will give you only an incomplete teaser-result for free, and you will have to pay for the actual outcome.

    In this post, I focus not on such paid online depression tests but on all those simple free tests that offer you only a handful of questions.

So what do these simple tests ask you? Let’s take #1 from the top of our Google “depression test” search page: a strangely anonymous website called My Depression Test. This is a simple list of 18 items; for each one you can score 1-6 on a scale from “Not At All” to “Very Much”. Here is their complete question list:

     1. I do things slowly.•
     2. My future seems hopeless.•
     3. It is hard for me to concentrate on reading.•
     4. The pleasure and joy has gone out of my life.•
     5. I have difficulty making decisions.•
     6. I have lost interest in aspects of life that used to be important to me.•
     7. I feel sad, blue, and unhappy.•
     8. I am agitated and keep moving around.•
     9. I feel fatigued.•
    10. It takes great effort for me to do simple things.•
    11. I feel that I am a guilty person who deserves to be punished.
    12. I feel like a failure.•
    13. I feel lifeless – more dead than alive.•
    14. My sleep has been disturbed – too little, too much, or broken sleep.•
    15. I spend time thinking about HOW I might kill myself.•
    16. I feel trapped or caught.•
    17. I feel depressed even when good things happen to me.•
    18. Without trying to diet, I have lost, or gained, weight.

Note that 9 out of these 18 questions (the ones I marked with a red dot •) if you put them in other words, in fact each simply ask you the very same thing: “Do you feel depressed?”
    And 7 of the remaining 9 questions (the ones with a green dot •) do in fact also each ask the same thing: “Do you have trouble doing things in a satisfactory way?”

So actually, the entire list boils down to two main questions that you repeatedly have to give your score for:
     1. (7 times) Do I have trouble doing things in a satisfactory way?
     2. (9 times) Do I feel depressed?
To which it adds only two really different items:
     3. Do I feel guilty?
     4. Do I have inexplicable weight changes?

At the same time, several obvious and essential questions have been completely left out. For example, one of the key questions that has been omitted is: do I have intermittent depressed and happy periods, or do my feelings of depression stretch out continuously over a period longer than a few weeks?

So far for the vapid shallowness of the whole thing: the entire list does little more than “measuring” and confirming what you already hoped, feared, felt, or knew. But there are many more problems here.

    One problem is of course the arbitrary character of this test. Because there is not enough variety between the questions and because most of them ask directly about how you feel, the result becomes highly dependent from how you happen to feel when filling it in. Doing this same test at 9 in the morning may give you a different score from doing it at 9 in the evening.

    The test is also arbitrary in another way: to score for each question, you are asked to choose between options such as “Just a little”, “Somewhat” or “Moderately”. What another person would call “Somewhat”, you might consider “Moderately”. This would be no problem if there were enough questions to compensate for incidental differences. But in combination with the very small number of questions in a test like this, this means that two equally depressed people might very well end up with a different end score.

    But there is a much more important problem with tests like this one. It is that they are far too easily manipulable. It is quite clear beforehand how your answer to for each question will contribute to your total “depression score”. In the test I listed above, “Not At All” is always good and “Very Much” is always bad. As a result, it is too easy to answer everything (intentionally or on a less conscious level) in a way that ensures you get the result you want or expect.

    In the much more extensive test forms used by professional psychologists and psychiatrists, there are usually mechanisms built in to prevent this undesirable effect and to guarantee a more objective outcome. Like, the same thing will be asked across the list in four completely different ways to check your consistency; scaling questions will be alternated with yes-or-no questions and open-end questions. And there will be reverse-questions: meaning that a “Very Much” answer might be bad for one question but good for another question. With such a professional test, it is more difficult to predict all the time what you are supposed to answer, and therefore the total of your many scores will be more honest and objective.

    Such professional tests also take into account that there are different kinds with depression with very different symptoms. Guiding you along that variety of symptoms, for example using a tree-pattern setup like I mentioned before, they will in the end not just determine how depressive you are. Rather, they will – as a preliminary diagnosis – indicate what kind of depression you may be coping with.

    The primitive online test example above does no such thing. Apart from sleep and weight loss-or-gain (and it does not differentiate between loss or gain) it almost seems to presume there is only one, vague, general kind of depression with similar symptoms for everyone. And with this primitive kind of test, an incidental one-day somber mood can easily be labeled wrongly as “depression”.

    It takes a professional psychiatrist not just a much more extensive and intelligently constructed test form, but also a few hours of thorough and probing talks with you before she can arrive at a real diagnosis. This investigation is what she needs both to determine the seriousness of your depression, and to establish what specific kind of depression you are coping with.

    Are you really naive enough to believe that a shallow, deficient, suggestive, primitive online mini-test like the one I dissected above can contribute anything that comes even near to a real diagnosis? Do you really think there is any reason to take the verdict of such a test seriously?

    As I said at the top of this post, at best such an online test provides you only with some kind of label, a kind of badge that is based on superficial and doubtful grounds. If a Depression Badge is what you need, so be it.

    But for some people these tests can be dangerous too, in more than one way. They may provide you with a false assurance or a false certainty. They may, by giving someone the badge “you are indeed extremely depressed”, thrash that person’s last hopes and only worsen the depression: self-labeling is not always wise. Or they may give a very depressed person the badge “you are indeed somewhat depressed but it’s only moderate”, thereby tempting him to wait a little longer before seeking actual help.

Summary:

These short online depression tests are incomplete, superficial and methodically totally inadequate. They will not tell you anything you didn’t in fact already feel or know. They will not help you any further. They may label you in a way that is not always correct or wise. And they may leave you with a false and unfounded feeling of certainty.

In fact, trying to do an online crossword puzzle might be much healthier and much more useful to you, than doing one of these online depression tests.

• tip: Just trust your own feelings. The depth and persistence of your own depressive feelings should tell you if you need to seek help, not some superficial online test.
    And let me add one specific warning: beware of “depression tests” on websites that at the same time want to sell you some product (a therapy, medication, self-help book, whatever). Those websites might have an interest in their “test” telling you that you are depressed.

 
Author: Henk van Setten