Selling Sickness 2013

personal experience with a mental health screening tool

I (K.W.) recently went to the gynecologist for my annual exam.  The office gave me the usual paperwork, but this time I noticed something new — a checklist about my mental health.

It asked, “Over the last 2 weeks have you... had little interest or pleasure in doing things, trouble falling or staying asleep, trouble concentrating on things such as reading newspaper or watching television, have you been feeling that you let yourself or your family down, thoughts that you would be better off dead, etc.?”

I was surprised and wondered why this kind of checklist would be given to patients at their annual OB/GYN  appointment.  I wondered if anyone else would notice that the questionnaire was created with an educational grant from Pfizer, Inc.?

I declined to complete the questionnaire and asked my doctor why it was being used. She responded that it would help her patients feel more comfortable talking about mental health issues. But she hadn’t had any specific mental health training around it, and using it wasn’t really her own idea. It was not part of any research study. Apparently, this screening questionnaire had been adopted company-wide to be used with all patients at all clinics to help address the “unmet mental health issues of our community.”

This kind of brief self-report inventory has been criticized both for its lack of validity and its potential for overdiagnosis and overtreatment. Its smooth standardization may reveal or conceal. Unless it is followed up by knowledgable interviewing, it may do as much harm as good. If  OB/GYN care is henceforth going to include mental health, I can think of lots better ways to start a conversation.

These things are popping up all over, however, especially in nonmedical settings like schools where parents may hope that checklists will keep their kids safe. We’ll talk about this kind of disease-mongering development at our conference next February.

Here’s the Screening tool.

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