An Epidemic of Bad Infographics: Depression

In an effort to keep trying to get people’s attention in an increasingly attention-deficit world, we get a lot of inquiries for links to websites promoting education programs and other affiliate websites. The latest effort is focused around “infographics,” those graphics made popular by the USA Today newspaper that combines an interesting graphical element with hard data. A well done infographic ostensibly makes data more engaging. A fantastic infographic puts data into proper perspective and gives it valuable context.

What these marketing firms send me, however, are not fantastic or even well-done. So in the interests of demonstrating that any infographic can be worse than no infographic, I’m going to critique one of the latest ones to have come across my desk. It’s about depression, one of the most common and serious mental disorders.

This is going to be fun.

The title of the infographic is “The Depressing Statistics about Anti-Depressants.” A good topic to cover, given how widely prescribed antidepressants are, even for people who don’t meet the criteria for clinical depression. The sub-title is, “The drugs your doctor prescribed for your depression could be doing more harm than good.” Okay, that sounds like a reasonable premise, let’s see how it’s backed up by the data and graphics in the infographic.

But before we do that, let’s also just note who is sponsoring this infographic, because it’s important to know an author’s bias. ADrugRecall.com is a lawyer referral website that specializes in connecting consumers with lawyers who sue drug companies when the consumer has suffered a bad side effect (or worse) from a drug. It’s run by a conglomerate (“brought to you by eJustice, a division of CMTM, Inc.”) that hosts dozens of these kinds of websites, each specializing in some specific topic where litigation is assumedly very profitable.

The infographic continues:

Side effects are common in all antidepressants. For many people, the side effects are serious enough to make them stop taking the medication.

There is a danger that, in some people, antidepressant treatment will cause an increase, rather than a decrease in depression; and with it an increased risk of suicide.

All of which is true. What isn’t said is that the “some people” is actually “a very small minority of people.” The scare-mongering claim is made by exaggerating the actual prevalence of this “danger,” which is much less of a danger if your psychiatrist or doctor is carefully monitoring your antidepressants (as they should be doing anyway).

The first component after the introduction of the infographic is a listing of “Treatments, Top 10 Most Prescribed Drugs and Their Success Rate.”

How many things can you spot wrong with this graphic? First, 12 treatments are listed, not 10. And the data come not from an actual prescription database, like IMS Health, but from a self-report, support group social networking website.

How many of the 12 “prescribed drugs” are actually prescription drugs? Only 11. Amoryn, as the graphic notes, is a dietary supplement — not an antidepressant drug.

How many of the prescription drugs listed are available in the U.S. (the target audience of this infographic)? Only 11. Serzone hasn’t been available in the U.S. for over 7 years.

What do the numbers mean on the graphic? According to the infographic, the numbers are defined as: “Daily Strength users have personal experience with many prescription drugs and have reviewed each of the following drugs. Each drug has been given a percentage based on these reviews.”

Huh?

So the numbers don’t relate to the actual prescriptions made, but their “success rate.” So does this mean that 81% of people who take Serzone experience “success,” compared to only 48% of people who take Luvox?

No, according to Daily Strength, the percentage refers to how many of their users (not a randomized sample, by the way) found the treatment helpful that percentage of the time. So Daily Strength users found the vast majority of antidepressants helpful more than 50 percent of the time.

What about your level of depression? Well, according to the infographic — but not the research or mental health professionals — you can have different “depression levels” ranging from “Normal” (what’s a “Normal” depression?) to “Situational” or even “Major.”

Of course, the Diagnostic and Statistical Manual of Mental Disorders (the DSM-IV) doesn’t divide major depression in this manner. Instead, it specifies that major depression can be Mild, Moderate, Severe without Psychotic Features, Severe with Psychotic Features, In Partial Remission, In Full Remission, or Chronic.

I assume “Situational” refers to a completely different mental disorder — Adjustment Disorder with Depressed Mood. The person designing this graphic was obviously not too familiar with the actual information he was asked to illustrate.

Next we come to the 11 “depression symptoms.” Yes, you read that right — 11. The DSM-IV only lists 9 symptoms of depression, but for some reason the author of this infographic took it upon himself to leave out some of the official diagnostic criteria and replace them with his own. For instance, “low self-esteem,” “headaches or chronic indigestion” and “low tolerance for stress” are not symptoms of major depression.

However, significant weight loss while not dieting or significant weight gain is a symptom of depression — but is notably absent from the infographic. Observable psychomotor agitation or retardation is also an important symptom of major depression, but also missing from the list of depression symptoms.

In fact, the infographic gets is completely wrong by noting “restlessness” is a symptom of depression. The DSM-IV specifically says, however, that one of the symptoms can’t be “merely subjective feelings of restlessness or being slowed down” — it must be observable by others (an important difference left off the infographic). “Hostility” is also not listed within the criteria for major depression.

Last, the one thing you’d hope an infographic gets right are the actual graphics representing the data. Not so this one, because apparently someone can’t count. (This is my favorite part.)

Graphical representations must be accurate — otherwise they lose their impact. If you’re sloppy with the graphics, it shows that not only don’t you care if you’re getting the data right — you may be seen as purposely misrepresenting the data.

Notice the total number of people in this part of the graphic for each of the 3 data points is 11 (not 10). So “Fewer than 50%” should be 5 out of 11 people — not the 6 listed. 90% of 11 people is 9.9 people — not the 10 listed.

But worst of all is that 6.6% of 11 people is not 1 person. It’s 3/4 of 1 person. Or a better graphic representation would be 1 whole person of 15 people (so add 4 more people to that bottom one and it’ll be accurate). It really says something about your infographic when the graphics are simply wrong like this.

Needless to say, the infographic is also poorly sourced, with only four references, three of which are just broad informational pages about depression or antidepressants.

I hope infographics don’t become any more popular, because in an effort to demonstrate data in a simpler and more engaging manner, they also have the danger of “dumbing down” the data, so people wouldn’t even notice these kinds of factual errors and inaccuracies. Of course, that’s what you can expect when the infographic isn’t done by a newspaper, magazine or a publisher that has some modicum of respect for the data.

View the whole infographic here.