The quality and accessibility of Australian depression sites on the World Wide Web

Kathleen M Griffiths and Helen Christensen
Med J Aust 2002; 176 (10): 97. || doi: 10.5694/j.1326-5377.2002.tb04509.x
Published online: 20 May 2002


Objectives: To provide information about Australian depression sites and the quality of their content; to identify possible indicators of the quality of site content; and determine the accessibility of Australian depression web sites.

Design: Cross-sectional survey of 15 Australian depression web sites.

Main outcome measures: (i) Quality of treatment content (concordance of site information with evidence-based guidelines, number of evidence-based treatments recommended, discussion of other relevant issues, subjective rating of treatment content); (ii) potential quality indicators (conformity with DISCERN criteria, citation of scientific evidence); (iii) accessibility (search engine rank).

Results: Mean content quality scores were not high and site accessibility was poor. There was a consistent association between the quality-of-content measures and the DISCERN and scientific accountability scores. Search engine rank was not associated with content quality.

Conclusions: The quality of information about depression on Australian websites could be improved. DISCERN may be a useful indicator of website quality, as may scientific accountability. The sites that received the highest quality-of-content ratings were beyondblue, BluePages, CRUfAD and InfraPsych.

It has been estimated that 6.4 million Australian adults — almost half the adult population — accessed the Internet during 2000.5 Reportedly, more Internet users search the Web for information on depression than any other health condition.6 This is not surprising given the high level of disability associated with depression in the community7 and the fact that the Web provides a convenient, anonymous means of obtaining information about the problem. However, much of the depression information on the Web is of low quality8-10 and originates in the United States. If Australian consumers are to benefit from Web-based media, they need to know which sites are of high quality and appropriate to local needs.

Because consumers are more likely to trust information on a website that is recommended by their doctor,11 general practitioners are uniquely placed to advise people about which depression websites to visit.11 However, there are currently no systematic guides to Australian depression websites on which GPs can base their advice.

Another way that consumers or non-specialist healthcare providers might judge the quality of sites is by indirect indicators that do not rely on specialist knowledge. Although many such indicators have been proposed, their validity as markers of content quality has not been established.8,12 Recently, the DISCERN scale13 has generated considerable interest as a potential indicator of website quality. In particular, the scale is intended to assist people without content expertise assess the quality of written health treatment information by systematically rating a number of attributes of a publication, such as the extent to which it describes treatment alternatives and their risks and benefits; the degree to which the information appears balanced and unbiased; and whether the publication documents areas of uncertainty. To our knowledge, there have been no studies of the validity of DISCERN as an indicator of the content accuracy of Web-based or other written health material.

Here we intend to:

  • provide information for consumers and healthcare providers about Australian depression sites and the quality (accuracy and comprehensiveness) of their content;

  • explore the validity of the DISCERN system as an indicator of the quality of treatment content; and

  • determine the accessibility of Australian depression websites.


The methodology used in this study is an extension of that described in our previous study of the quality of "popular" international depression sites.8

Identification of Australian depression sites

Potentially relevant Australian depression sites were identified (November to December 2001) by entering the query term "depression" into each of 17 Australian search engines and six major search and metasearch engines that permit searches restricted to the Australian domain.14,15 Only sites appearing in the top 200 results of a search engine list and containing at least eight internal Web pages focusing on depression were included. Three additional, newly released sites not returned by the search engines were also included.

Twenty-seven sites were found. Of these, 12 (clearing house, bipolar disorder, postnatal depression, web-based cognitive therapy) were excluded from formal analysis, leaving 15 sites (Appendix).

Quality of content
Evidence-based and non-evidence-based scores

The number of evidence-based treatments (evidence+) (maximum, 8) and the number of non-evidence-based treatments (evidence−) (maximum, 26) (Box 1) that were recommended as effective were calculated for each site. Evidence-based treatments were defined as those interventions that are supported by a systematic review of the evidence as effective.17 Non-evidence-based interventions were those which, on systematic review of the available evidence, do not seem to be effective or which have been the subject of little or no appropriate research.17

Site characteristics and coverage

The site characteristics are summarised in Box 2. All sites provided information for consumers. Significantly, only a third of the sites had an editorial board. All sites published some treatment information and most included information about symptoms and diagnosis (14 sites), prevalence (13 sites), stigma reduction (11 sites), risk factors (11 sites), and resources (10 sites). Half the sites provided a self-assessment screening test on the site. Only four sites included information on prevention and only four had information on specific groups. Four sites included a bulletin board and two had chatrooms, but none provided online counselling or psychotherapy.

Quality of content
Associations between content quality, potential quality indicators, and accessibility

Box 3 shows the intercorrelations between each of the content and potential quality indicator scores. With one exception (evidence–), all content scores (guideline, issues, evidence+) were significantly correlated with each other and with the DISCERN "overall rating" score. There was also a significant correlation between the extent to which sites mentioned scientific evidence in support of treatments (scientific score) and scores on all content measures except evidence–.

There was no relationship between the accessibility of a site (as judged by the number of search engines retrieving it in the top 10 or the top 200 results) and the quality of the site (as judged by any of the content or other measures and excluding the new sites InfraPsych and BluePages, which would not have been indexed by public search engines at the time of the study).


We have systematically identified Australian websites that provide information about depression. On average, scores on measures of content quality were relatively low, a result that is broadly consistent with the conclusions of previous studies that, overall, the quality of depression information on the Web is not high.8-10

Nevertheless, there was considerable variability in the comprehensiveness and the quality of sites, and all sites had strengths as well as weaknesses. The consistently best-scoring sites included two university-based sites (BluePages and CRUfAD), the site of the National Depression Initiative (beyondblue) and the privately owned site InfraPsych (Box 4). These sites had the best average ranks across the four main content measures (guideline, issues, evidence+, global), and achieved top scores on the evidence-based guideline scale and top ratings on at least three of the content measures. Other specific advantages of these sites are summarised in Box 4.

Several other sites were notable in providing useful information with respect to particular aspects of depression. These were Depression (offers extensive information about depression management and methods of coping with antidepressant side effects), myDr (includes a searchable MIMS database), and DepressioNet (provides consumer support and networking, extensive lists of sources of help). Dark Side of the Mood stands out for its accessible and concise presentation of above-average quality of content.

Despite their limitations, all sites provided useful information. The fact that all or most sites indicated that depression can be treated, encouraged patients to seek expert advice, attempted to destigmatise depression and indicated that antidepressants are effective and non-addictive treatments is likely to encourage help-seeking and facilitate treatment compliance. Providing information about symptoms, as most sites did, might facilitate correct diagnosis, as patients who self-label as depressed are more likely to receive an appropriate diagnosis.18

On the other hand, there is a clear need to improve the coverage and the accuracy of content in a number of areas, including details of the recommended duration of antidepressants to avoid relapse, the time needed to trial an antidepressant and the importance of ceasing antidepressants slowly to avoid discontinuation effects. This information could improve compliance, lessen the likelihood of relapse and premature abandonment of effective treatments, and, by avoiding discontinuation symptoms, improve the likelihood that patients will be willing to take antidepressants in the future. Sites also need to provide more information about the relative effectiveness of different treatments (eg, that cognitive behaviour therapy is as effective as antidepressants for mild to moderate depression). Currently, many sites recommend "counselling" as a treatment for depression, although supportive therapy is not by itself an effective intervention for depression. More generally, sites should ensure that they consider the consumer perspective, both with respect to content and style.

Finally, there is a need to provide comprehensive, high quality information about depression for adolescents. Currently, no site adequately fulfils this role.

Study limitations

Our study has a number of limitations. First, we are the joint authors of one of the sites (BluePages) and this might have influenced our judgements. In addition, one of the measures (evidence+) is based on a review of which we were co-authors and which forms the basis for the treatment section of the BluePages.17 However, the general pattern of the results does not change if BluePages is excluded from the analysis.

A second limitation of this study is that the judges rated the sites on both content and potential quality measures. Future studies using different raters for these measures and a larger sample size are needed.

In addition, this study did not incorporate evaluations by consumers. We plan to conduct further studies using DISCERN and other ratings produced by consumers and non-technical assessors.

We also acknowledge that websites are rarely static and that no account was taken of information on linked external sites.

A final limitation of this study is that it is confined to depression information. Online counselling is becoming increasingly popular. DepressionNet alone claims to attract more than 1 000 000 visits per quarter. Clearly, the next challenge will be to develop methods for assessing the quality of online counselling services and online support groups.

1: Evidence-based and non-evidence-based treatments counted in assessing the websites17

Evidence-based treatments



Cognitive behaviour therapy

Electroconvulsive therapy


Interpersonal therapy

Light therapy (seasonal affective disorder)

St John's wort

Non-evidence-based treatments

Alcohol for relaxation

Caffeine avoidance


Colour therapy

Dance therapy

Fish oils

Ginkgo biloba





Lemon balm



Natural progesterone




Pleasant activities


Sugar avoidance

Supportive counselling



Vitamins (other than folate)

  • Kathleen M Griffiths1
  • Helen Christensen2

  • Centre for Mental Health Research, The Australian National University, Canberra, ACT.



This study was funded by NHMRC New Program Grant No. 179805. We would like to thank Kimberley Evans, Claire Kelly, Sara Vancea, and Rhonda Sattler for their assistance with the project.

Competing interests:

Kathleen Griffiths and Helen Christensen were co-authors of the depression website BluePages, which was included in this review. They are also co-authors of a review of the effectiveness of interventions for depression17 on which one of the quality-of-content measures was based.

  • 1. Australian Bureau of Statistics. Household use of information technology, Australia. Canberra: ABS, 2001. (Catalogue no. 8146.0.)
  • 2. Taylor H. Explosive growth of "cyberchondriacs" continues. (The Harris Poll #47) 5 August 1999. <>. Accessed 26 January 2001.
  • 3. Murray CJL, Lopez A, editors. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Cambridge, MA: Harvard University Press, 1996.
  • 4. Griffiths KM, Christensen H. Quality of web based information on treatment of depression: cross sectional survey. BMJ 2000; 321: 1511-1515.
  • 5. Gretchen K, Berland MD, Elliott MN, et al. Health information on the Internet: Accessibility, quality, and readibility in English and Spanish. JAMA 2001; 285: 2612-2621.
  • 6. Lissman TL, Boehnlein JK. A critical review of internet information about depression. Psychiatr Serv 2001; 52: 1046-1050.
  • 7. Cain MM, Sarasohn-Kahn J, Wayne JJ. Health e-people: the online consumer experience. Five-year forecast. Oakland, CA: California HealthCare Foundation, 2000. Available at <>. Accessed 27 January 2001.
  • 8. Jadad AR, Gagliardi A. Rating health information on the internet: navigating to knowledge or to Babel? JAMA 1998; 279: 611-614.
  • 9. Charnock D, Shepperd S, Needham G, Gann R. DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health 1999; 53: 105-111.
  • 10. The Major Search Engines, Metacrawlers, Regional search engines. In: SearchEngineWatch. <>. Accessed November 2001.
  • 11. Searchme. The definitive list of Australian search engines and directories. In: The Web shed. <>. Accessed November 2001.
  • 12. Centre for Evidence Based Mental Health, University of Oxford. A systematic guide for the management of depression in primary care: treatment. 1998. <>. Accessed 27 January 2002.
  • 13. Jorm A, Christensen H, Griffiths K, et al. Help for depression: what works (and what doesn't). Canberra: Centre for Mental Health Research, 2001.
  • 14. Hickie IB, Davenport TA, Scott EM, et al. Unmet need for recognition of common mental disorders in Australian general practice. Med J Aust 2001; 175 Suppl Jul 16: S18-S24.
  • 15. Silverstein C, Henzinger M, Marais H, Moricz M. Analysis of a very large Alta Vista query log. SRC Technical Note 1998-014. California: Digital Systems Research Centre, 1998.


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