Our online activity generates a wealth of data that may help with predicting and preventing mental health challenges before they unravel. This summer, Google rolled out a depression assessment tool, the PHQ-9, to US-based mobile users. The PHQ-9 [you can read a study on it here] is a standardized set of questions that’s commonly used in clinical and research settings to gauge the severity of depression. if you search for things related to depression, the search engine is supposed to ask if you’d like to take the assessment. So we decided to test it out and see how it gets triggered and what advice it’s giving people if they do score high on the test. Since EHAB HQ is in Canada, we asked some of our intrepid community members south of the border, Lea and Andréa to Google sadly and see what happened.

Triggered much?

I asked Lea and Andréa to search for things they would have actually searched for or could remember searching for when they’d been wrestling with their brains themselves. But it doesn’t look like the triggers for the questionnaire are especially nuanced or intelligent. As Lea explained: “I put in terms I would google when I was down, but the specific screen with the test didn’t come up. I put in stuff like ‘loss of appetite and crying all the time’, ‘why am I sad all the time’, ‘thoughts of killing myself’, ‘why do I hate everything now'”. But Google only prompted her to try the questionnaire when she mentioned the word “depression”.

Andréa had a very similar experience: “It seems you pretty much have to know you are depressed to get a link that addressed the issue.” But here’s the thing: she was searching on Google, in the US, on mobile, but the PHQ-9 quiz never got triggered. She just got the usual list of results, including a depression quiz from a quiz mill that specializes in “eerily accurate personality tests”–probably not the best place to get accurate mental health treatment info. Although it’d be a great place to find out which pop star has the same personality as you… The answer is Zayn, definitely Zayn.

Here’s what it’ll look similar to if you trigger the PHQ-9 assessment while using Google’s search engine:

Image of the depression quiz prompt on Google.

The Real Issues

Both Lea and Andréa initially searched for things that are similar to topics the PHQ-9 actually asks about. Appetite and suicidal thoughts are components (separately) of questions on the quiz. The first search Andréa did was about feeling hopeless and “hopeless” is a word specifically used in one of the questions on the PHQ-9. So Google wouldn’t have to look far to expand the triggers for the quiz. To trigger the assessment more often and to reflect the reality of what people might be searching for, Google could at least include the topics covered on the assessment. They could probably go much further than those topics and even get into predicting the early onset of things like depression with the data they have on your online habits, schedule, and location, but would you want them to do that?

How much do you want to know about what Google knows about your brain?

Personally, when I was struggling with mental illness, it never occurred to me that I actually had any mental health issues, even as the symptoms became more extreme. I wasn’t searching online explicitly about mental illnesses. But in retrospect, all of my online activity was fuelled by the stuff going on in my head. It seems like Google would be best positioned to pick up on this. Google can see when we’re compulsively visiting websites, when we’re online late at night because we’re not sleeping, when our activity levels drop, when we’re booking fewer social events in our calendars, when we’re compulsively checking email, procrastinating on YouTube, compulsively buying things we don’t need… but do you want your search engine pointing out that you’ve looked up your ex’s social media profiles every day for the past week even though you haven’t put her name in your calendar in over a month? Does Google want to point out all of the unhealthy things you’re doing online that generate money for them? They could be making money off of your purchases when you’re on a manic buying spree at 3am. Is there a massive conflict of interest here if we expect Google to be watching out for our mental health?

So what happens if the quiz says you’re depressed?

This is understandably tricky territory for Google to navigate. They may want to help people find useful information to help with overcoming depression, but that takes Google into content creation territory. After somebody does the test, should Google be displaying research from Google Scholar that explains the most effective treatments for depression? The current version [see image below] tells people they can find “relief” through “treatment, therapy and wellness practices”. But what’s the difference between treatment and therapy? Evidence-based therapy for depression would be the evidence-based treatment, but not all therapies or therapists are uniformly effective. So where should people go if the test does tell them they’re dealing with depression? Should it explain that depression is a common element of many mental illness diagnoses so this might be pointing to other issues?

Getting help for mental health can be a complex, challenging adventure. Anything to get the adventure started sooner is helpful, but after doing the quiz, the next steps are rather vague. As Lea pointed out: “When I was a teen and was depressed, I don’t think I would have found this helpful. Maybe helpful knowing I was depressed, but not knowing where to go from there. You can’t just walk into a center somewhere and ask to see a therapist. It’s a complex process.”

There are no easy answers to this challenge, so I appreciate that Google is at least trying something. With some deeper exploration into the realities of recover journeys up and over mental illness, this could evolve into a set of tools that help people spot problems sooner and get effective, accessible help.