Wednesday, August 19, 2020

What is a case of depression in the coronavirus period? A case for what?

The Office for National Statistics (ONS) reported yesterday that the Patient Health Questionaire (PHQ-8) scores for most people had increased in June 2020 compared to a score recorded sometime between July 2019 and March 2020 (although had actually decreased for 3.5% of the population). Considering the anxiety caused by coronavirus, social distancing and lockdown, I guess this finding should not be surprising.

These figures were used by the Royal College of Psychiatrists to warn again about a "looming mental health crisis and the tsunami of referrals we are expecting over the coming months" to reinforce their argument for significant investment in mental health services (see Guardian article). Headlines were that depression had doubled during the coronavirus period. But as Elaine Fox said to BBC news online, "It is important to remember that this [PHQ-8] does not give a diagnosis but rather an indication of everyday depressive feelings and behaviours". Certainly it’s misleading to imply that the number of depression cases has doubled because of coronavirus.

I don't want to underestimate the impact of the pandemic on mental health. But I'm not necessarily convinced there will be an inevitable vast increase in cases coming forward for, or even needing, antidepressants, psychological therapy or other mental health treatment. We've all had to adjust to it, and such adjustment does not necessarily create mental health problems.

I'm reminded of the book of the symposium What is a case? (1981) edited by Wing et al. As David Goldberg noted (see article), a contribution at the symposium by:-

Copeland (1981) reminds us that the concept of a case is a chimera ... . Rather than regard the concept as a sort of Platonic ideal he suggests that investigators should ask - 'a case for what?'

Despite whatever symptoms are measured on the PHQ-8, people's coping mechanisms may not have necessarily broken down because of the pandemic; nor would they necessarily seek, or need, medical or psychological help even if they have difficulties. Feelings as recorded on the PHQ-8 may well be understandable in the circumstances. It is important to ask if the Royal College of Psychiatrists, for example, may be manipulating the ONS data to its own advantage to obtain more resources. I wouldn't want to discourage people who need help from coming forward, but they actually may have considerable personal resources and resilience to be able to overcome and adapt to any difficulties caused by the pandemic. Mental health treatment can be helpful, but it isn't always.

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