Misleading Headline: 30% of (Philippine) Government Workers Need to See Shrinks

Last January the 13th, an interesting front page article came out from the Inquirer: 30% of Government Workers Need to See Shrinks. It goes on to detail that "the most common mental disorder were depression and anxiety disorder" and that "30% were found to have mental health problems". Coming from experts in the field, it really seems that the conclusion was incontrovertible and that 1/3 of Philippine government workers really require "professional help, medication, or psychotherapy."

Of course, it's not a done deal for me. For example, the repercussions of such a headline shouldn't be taken for granted. In a country where most of the population view psychological help as the realm of the insane, I believe that there should be a little more responsibility when it comes to reporting such facts. Arguing from the other side, I also wanted to make a more charitable interpretation of the study, one that could make things clearer on the onset.

A closer look at the instrument
Let's first take a look at the diagnostic tool that was used in the study, since it's the primary research tool that was used. Created by the World Health Organization for epidemiological studies, the Composite International Diagnostic Interview (CIDI) measures the prevalence (i.e. the proportion of a population with a disorder) of 8 kinds of mental disorders; major depression, generalized anxiety, panic disorder, specific phobias, social phobias, agoraphobia, alcohol abuse and drug abuse were pointed out in their research. It was also designed to work across cultures, making it one of the most popular diagnostic tools for these kinds of studies.

One thing you have to understand about the CIDI is that it's a structured interview, meaning one only needs to follow a standard set of questions explicitly to complete its use. It's also like a diagnostic Choose-Your-Own-Adventure; you skip and move to questions depending on the answers of the client. Given the nature of its construction (actually, given the nature of any kind of diagnostic tool per se), we have to realize that it cannot give us 100% validity in terms of the mental disorder involved. For the statistically minded among you, the kappa coefficient of the test (i.e. a measure that tells us how accurate it is in diagnosing that there is a disorder) for anxiety disorders is only 0.53 or a moderate agreement. This tells us that the test wouldn't be enough to diagnose a person as having the specific kind of disorder, only that he needs further mental health services to investigate it further.

Given this, the 30% figure that was touted in the article - that is, the 30% who needs to see a shrink - is actually a ballpark figure, and the actual figure is a lot less.

A misleading article
Clinical psychologists, psychiatrists, and general psychology majors would probably understand the headline in context of the field. We have knowledge of validity coefficients and reliabilities so we also know what it means if someone says that a population has been found to have mental disorders. But the public does not know about this, and may misinterpret things as they are.

The article is very misleading because it presents the headline premise as the final conclusion on the matter: 1/3 of Philippine government workers have mental disorders. For the rest of the readers, this could be translated into: 1/3 of Philippine government workers are kooks and loonies. By virtue of only the diagnostic tool, it has been concluded that they need "professional help, medication, or psychotherapy" when the more accurate conclusion should be that they are at risk for mental disorders and may need further investigation.

It's good though that a day after, the Department of Health issued their clarification on the matter. The only mental disorders that were detected by the instrument were specific phobias (15%), alcohol abuse* (10%) and depression (6%) - definitely no loonies here. I wouldn't have to worry if the government worker have a specific phobia, not unless its with paper or with office equipment. Of course, these still merit further clinical diagnosis because these are symptoms of what may be a problematic social framework.

Be it as it may, I do hope that more responsible reporting ensues from this matter. Sensationalism shouldn't be at the forefront before truth.

* It's a bit strange that the article didn't report alcohol abuse as coming second to anxiety disorders, and why they didn't break down anxiety disorders into their specific categories - a phobia is not the only example of an anxiety disorder. Makes we wonder.. but that's for a different article, I think. - Rodge