Screening the public for depression through the Internet

Objective: Despite increased public screening, many individuals with depres sion remain undetected or untreated. This study explored the performance of an Internet-based program in screening for depression. Methods: The Center s for Epidemiological Studies Depression (CES-D) scale was adapted as an on line screening test. The program advised persons whose score indicated a hi gh probability of depression to seek treatment and asked them to complete a survey of attitudes and preferences that could be printed and taken to a h ealth professional. Responses were collected anonymously for epidemiologic research. Demographic characteristics of participants were compared with th ose of the U.S. population and participants in previous community screening s. The costs of the program were calculated. Results: The CES-D scale was c ompleted 24,479 times during the eight-month study period. The respondents' median age category was 30 to 45 years, and almost 30 percent were male; 5 8 percent (N=14,185) screened positive for depression, and fewer than half of those had never been treated for depression, The proportion of younger i ndividuals was larger than in previous public screenings, but was still low er than that in the U.S. population. Our sample contained a lower proportio n of minorities than the U.S. population (16.6 percent versus 28.3 percent) . Sunk costs totaled $9,000, and additional marginal costs to maintain the system totaled $3,750. Conclusions: The Internet provides a continuously av ailable, inexpensive, easily maintained platform to anonymously screen a la rge number of individuals from a broad geographic area. However, older adul ts and minorities may visit screening sites less frequently than other popu lations.