Many people believe that the great myriad of mental disorders we can choose from must be diagnosed by some sciencey-seeming test – involving fabulous technology that peers right into the inner workings of our brain to find faulty circuits – or at least require the drawing of our blood so some lab tech can check for imbalances in those brain chemicals that must get all outta balance an’ wibbly-wobbly like.
If only it were as simple as ticking a few boxes on a checklist, calling it a name and picking a prettily coloured tablet.
We’ll that is the fantasy we’ve built but it was never going to be that easy and researchers are now providing the evidence base of evidence based medicine is pretty thin, and deeply flawed.
Yet the questionnaires get simpler and more likely to lock even more kids into the diagnosis – drugs pipeline.
A new study published in Canadian Journal of Psychiatry shows what any kid knows – when life is more complicated than adults can handle they just make stuff up, lie through their teeth and tell you to shut up and do what they say.
The testing demonstrates that one handy-dandy, easy-peasy questionnaire – designed by a drug company no less – led to 22 percent of children being given a false positive diagnosis.
That’s not science, that’s guessing -or playing with loaded dice, take your pick – and if you can get away with it, a very lucrative business plan.
If your car mechanic operated on a similar hit-rate: diagnosing one in four cars with a fault they did not have then you’d take your business elsewhere, and they’d have investigative TV journalists all over their lot doing their utmost to reveal their dodgy practices to an unwary public.
In mental health they call it “science”.
It’s not science, it’s just bollocks.
Toronto Star, 5th Aug, 2016
Depression screening tests for children unreliable, study says
Doctors in Canada and the U.S. are increasingly using short questionnaires to identify depression in pediatric patients.
Common surveys used to screen for depression in children and teenagers are unreliable and may lead to misdiagnoses, a study in the Canadian Journal of Psychiatry says.
Because general practitioners in Canada and the U.S. are increasingly using short questionnaires to identify depression in pediatric patients, Brett Thombs, a clinical epidemiologist and psychologist in Montreal, set out to systematically review 20 screening tests to see how accurately they diagnosed depression in children ages 6 to 18.
“Our study shows that if depression screening were carried out using existing screening tools, many non-depressed children and adolescents would be mistakenly identified as depressed,” said Thombs, who is affiliated with the Jewish General Hospital’s Lady Davis Institute for Medical Research and McGill University’s Faculty of Medicine.
Thombs’ review found that one popular depression-screening questionnaire developed by a major drug company was accurate 78 per cent of the time. In other words, 22 per cent of kids who didn’t have depression screened positive.
“There is no evidence they can come close to giving valid diagnoses,” Thombs told the Star. “When used properly, psychiatric medications can help people. When used on kids who don’t have the diagnosis, they won’t see the benefit but they will face all the side effects.”
Thombs is also concerned about the effect screening would have on a health system that is already strained for resources.
“We have a terrible problem taking care of kids who have really serious mental health needs,” said Thombs. They’re seeing a generalist or family doctor or not getting care at all or they’re on a terribly long waiting list. Or they’re prescribed medications when behavioural treatments would work better but they’re not able to access those treatments because of wait lists or insurance problems. If we’re going to bring in massive numbers of kids whose needs aren’t as recognizable, we have to ask, ‘Who are we going to treat less?’”
Earlier this year, a federal task force in the U.S. recommended routine depression screening for adolescents in primary care settings. In Canada, provincial governments in Alberta, British Columbia and Manitoba have called for widespread depression screening.
Thombs — who conducted the review with colleagues in Quebec, Ontario, Manitoba and Alberta — said he’s spoken with primary care physicians who are using the screening questionnaires not as a stepping stone to a deeper investigation that includes a lengthy diagnostic interview but to confirm a diagnosis of depression and prescribe medication.
“Hopefully, there aren’t many service providers out there who would administer a questionnaire and prescribe medication based on that questionnaire,” said Dr. Joanna Henderson, a clinical psychologist and scientist in the child, youth and family program at the Centre for Addiction and Mental Health in Toronto.
Henderson has worked with communities across the country to implement a screening tool that targets both addiction and mental health issues, opening the door so these conditions can be treated together. The screening tool she used wasn’t evaluated in Thombs’ review.
She sees screening tools not as a path to diagnosis and drugs but as an important way to identify young people in distress and align them with services that can help.
“We know that many young people experiencing difficulties don’t reach out for assistance. Often, by the time young people do receive treatment, they’re far along in their difficulties.”
“I think it’s clear from this review that more work needs to be done,” Henderson said. “We wouldn’t recommend that any service provider, physician or non-physician, use only a screening tool to base their treatment plan on. The intention of a screening tool . . . is to identify which young people need more attention. Which young people should have a further assessment of what’s going on? Based on that assessment, we make treatment recommendations, which may or may not include medication.”
The number of high-school students who reported taking prescription drugs for anxiety and/or depression has doubled to 6 per cent (39,300) since 2001, according to CAMH’s latest annual survey on drug use and health among Ontario students.
Nearly 20 per cent of Ontario students rated their mental health as fair or poor, up from 11 per cent in 2007 .
We couldn’t find the publication online but here’s the announcement from the commencement of the study in 2012.
- Depression screening and mental health outcomes in children and adolescents: a systematic review protocol http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3563607/