Media

Is depression overdiagnosed?
Is Depression Overdiagnosed? A leading psychiatrist told the BBC in August, that too many people are diagnosed with depression when in fact they are just unhappy. Up and down the country news headlines were run claiming that depression is overdiagnosed.

Is Depression Overdiagnosed?

A leading psychiatrist told the BBC in August, that too many people are diagnosed with depression when in fact they are just unhappy. Up and down the country news headlines were run claiming that depression is overdiagnosed.What caught the media’s attention was
a lively debate in the British Medical Journal (see www.bmj.com/cgi/content/full/ 335/7615/328) asking the experts ‘Is depression overdiagnosed?’ Professor Gordon Parker at the University of New South Wales in Australia said it certainly is. His opponent, Ian Hickie from the University of Sydney, argued that
it is not.

Parker’s main thrust was that loose definitions of depression lead to overdiagnosing and absurd prevalence rates. He cited his 1978 study of 242 teachers, where 95 per cent reported feelings of depression (defined as ‘a significant lowering of mood, with or without feelings of guilt, hopelessness and helplessness, or a drop in one’s self-esteem or self-regard’). A mean of six such episodes a year indicated to Parker the ubiquitous nature of depressed mood states. By 1993, 79 per cent of the sample met the criteria for major, minor or subsyndromal depression.

Parker’s data seem to support more than one conclusion: depression is overdiagnosed, or living in Australia and working as a teacher makes you depressed! Unfortunately, the 1993 follow-up is unpublished, so the nitty-gritty of what criteria and measures his team used to make the diagnoses is unclear. Face-to-face interviews are more reliable at diagnosing ill health than questionnaires.
Parker considered one leading cause of overdiagnosis that does ring true: increased drug marketing. This may link to today’s surge in antidepressant prescribing, also reported in the BBC this year.  

On the other side of the fence, however, Ian Hickie argued that many people are still missing out on lifesaving treatment.

He put forward a strong case, the theme of which only The Guardian picked up.  

Hickie argued that increased treatment over the past 15 years has led to benefits, such as reducing suicides and increasing productivity. He also said that providing treatment for depression is cost-effective. For these reasons, he claimed, it is not being overdiagnosed.  
Parker rightly pointed out that the different editions of the American Psychiatric Association’s Diagnostic and Statistical Manual have had different criteria for diagnosing depression. These have led to different prevalence rates, and he concludes an overdiagnosis with the DSM-III definition compared to the DSM-II edition. But doctors use common sense as well as diagnostic criteria. Hickie argued that most doctors can differentiate normal sadness from more severe clinical conditions.

Hickie also made another point, which the media missed. He said that because more people are being diagnosed with depression, there is more research. This has uncovered key factors linked to depression and opportunities to look at prevention. However, more research does not mean the problem is diagnosed properly.

Which side did the media take? The BBC, The Telegraph, the Daily Express, and Manchester News ran with the story that depression is overdiagnosed. But The Guardian attacked the claim, citing Marjorie Wallace of SANE, who worries that using harsher criteria to diagnose depression could risk not giving treatment to people who really need it: a risk with grave consequences, given that the cost could be suicide.  

To cover all views, the Daily Mail ran two stories, one with the overdiagnosis theme and one attacking the first story with the headline ‘Experts attack depression claim’.

So who won the debate? Looking at media coverage, Parker’s overdiagnosis theme gained more column inches. Grabbing headlines is about what is newsworthy: people are more likely to
read a story about doctors overdiagnosing
a problem, than one about the benefits of treating it properly.  

But the media caught our attention and the effect has been worthwhile. Clinicians are talking, airing their views and thinking about the issue – the best possible outcome of media coverage.  
    

Jennifer Wild

 

So it’s goodbye to Dr Tanya Byron as a TV parenting guru. According to the interviewer in The Times, she is ‘walking away from the media juggernaut to protect the integrity of her first love, clinical psychology, which she says will always be her priority and which she will never give up’. She’s sharp, Dr Byron, and in a move that could be seen as killing the golden goose by pulling up the rope bridge as it walks across it, her final act is to implicitly question the need for expert advice – her new book is called Your Child…Your Way.

There appear to be many reasons for her decision, but I hope that her main one isn’t encapsulated by her quote: ‘There are other programmes you do see which are either run by people with no training or it’s completely car-crash telly and you think “How did that family end up on TV because they so shouldn’t be there?” And that’s when I do start to think “Oh God, where is this going?”’ This seems to be a common ethical dilemma facing psychologists these days: if some psychologists are doing it badly, should I do it at all?

Personally I think it makes it all the more important, and in particular it seems a shame to leave behind rare and vital relationships with production teams. But perhaps Dr Byron’s main legacy to psychologists in the media lies in her demonstration that an emphasis on professional qualifications, ethics and evidence-based intervention does not have to get in the way of making ‘good telly’. Let’s hope Byron herself bears this in mind as she branches out into new areas, one of which is to spearhead the government’s review of the availability of violent video games.
Jon Sutton

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