Quality of health information about depression on internet

Editor—Griffiths and Christensen evaluated the quality of web based information on the treatment of depression.1 Although they have tried to scrutinise the quality of a select group of websites, there are shortcomings in their methods that may have affected their findings. Griffiths and Christensen used just one search engine (DirectHit) and one meta-search engine (MetaCrawler), which limited the comprehensiveness of their search. Although the popularity of search engines changes rapidly, we question the choice of DirectHit over more often used engines such as AltaVista or Google.2 Therefore, it is difficult to justify the assumption of Griffiths and Christensen that their search method provided the best available approximation to a list of depression sites. We also question the strategy of using the single search term of “depression,” given that over 44% of internet users search using multiple keywords.3 The extreme narrowness of using a single keyword search was summed up eloquently by Brian Pinkerton, the founder of MetaCrawler, when he said: “Imagine walking up to a librarian and saying, ‘travel.’ They're going to look at you with a blank face.”4 Griffiths and Christensen attempt to assess the quality of information found by comparison with a guideline of the Agency for Health Care Policy and Research (AHCPR) guideline. Readers should be aware that tools, such as DISCERN (www.discern.org.uk), are readily available for appraising the quality of patient information. Furthermore, although the AHCPR guidelines were developed using an evidence based method, they were published in 1993 and may not necessarily reflect recent advances, alternative treatments, or local practice. Smarter search engines such as SumSearch (http://sumsearch.uthscsa.edu/) try to refine and guide users through the literature, yet a global initiative from the World Health Organization may provide further direction for users. The WHO has proposed the creation of “.health” as a new internet top level domain to afford some measure of protection for internet users by identifying the holder of the domain name as one who adheres to known standards.5 While the feasibility of “dot health” is being debated, national initiatives, such as the National Electronic Library for Health (www.nelh.nhs.uk) are striving to bring together high quality information for patients and health professionals. One of the initial examples of which is information on depression that can be found at http://cebmh.com/depression.html. Until initiatives such as dot health or high quality web searching tools become available, the onus will remain with users to search effectively and appraise the quality of the sites retrieved.