
DURHAM — On Thursday, an expert discussed the increased occurrences of false-positives in the current implemented screening instruments for mental illness in adolescents.
Dr. Allan Horwitz, professor of sociology at
Rutgers University, visited UNH to stress the mounting frequency of diagnosed depression in America’s youth and the unreliable tools to diagnosis it.
The DSM says to be clinically depressed one must suffer from a lack of interest in daily activities and be in a depressed state for at least two weeks. Additionally, one must experience at least five more symptoms from the DSM list, such as difficulty paying attention and suicidal thoughts.
“Five symptoms to meet the depression criteria is a pretty arbitrary number,” said Horwitz. “It’s unrealistic to assume any one is truly depressed based on the DSM criteria.”
This number was extracted from the current instrument used for screening adolescents: a simple questionnaire.
“Yes or no answers to diagnosis a serious illness, especially one that is inconsiderate towards temporary stressful events, is outrageous,” said Horwitz.
Graduate student Matthew Cutler of the
Justice Studies program agreed that “we have identified too many false-positives by blanketing the population of adolescents with this screening initiative.”
The questionnaire in question has quickly become a routine in many primary health care facilities, “much like a blood pressure test or cholesterol reading,” said the Times article.
The screening test gained notoriety in 2003 when
Congress, under
President Bush, budgeted $20 million for developing screening programs. Patient-advocacy groups of screening say alleviating the psychosocial deficits that accompany
depression is crucial to providing sufficient treatments, according to Horwitz.
Attendee Ryan Mitchell, 21, of Horwitz’ lecture sided with the Congress decision and said that he is not convinced screening is so bad.
“I knew some one in high school who committed suicide and I think the tell-all signs were there,” he said. “Maybe if he had taken a screening test, it would have been prevented.”
Meanwhile, Horwitz emphasized that “it is almost unquestionably true that the implementation of required screening among adolescents is too premature [for accurate diagnosis].”
In his lecture, Horwitz said that 84 percent of adolescents that screened positively for depression actually displayed a false-positive at the diagnostic stages.
This large number is contributed to adolescents who experience the tumultuous range of emotions when growing up, or the “the yo-yo of hormonal tendencies”. In most cases, younger individuals that are screened only experience short-term symptoms of depression, while “true depressive cases have endurance,” said Horwitz.
Most of the audience appeared to side with Horwitz and continually nodded their heads in agreement. At one point, one woman said, “That’s right!” when Horwitz said “children are unempowered individuals” that shouldn’t be diagnosed through something as mundane as a survey.
Additionally, Horwitz suggested that pharmaceutical companies are largely to blame for the mass depression. Over the course of 10 years, anti-depressant use has increased 350 percent.
Pharmaceutical companies are “very sneaky” about how they provide funding for screening. They are named as large philanthropic organizations, rather than pharmaceutical companies, that donate money for screening to avoid controversy.
“If it seems like our population is suffering from mass sadness, then we might be dealing with broader social issues that couldn't possibly be solved by administering anti-depression treatment on a grand scale,” said Cutler.
Though Horwitz was unable to identify a specific plan to improve the screening test process for adolescents, he said that ideally a test needs to be developed that does not “take attention away from kids who have real, serious, persistent disorders.”
He did say that developing screening tests sensitive to the context of depression is important to diagnosing adolescents. Horwitz, who was trained in psychiatric epidemiology and in deviance and social control, has written four books and dozens of journal articles pertaining to mental illnesses. His latest book,
“The Loss of Sadness,” was published in 2007.