Is What You’re Reading Junk? Evaluating the Quality of Mental Health Websites, Part 1

The internet allows patients, consumers, physicians, and other mental health care professionals to quickly access mental health information.

Millions of Americans search for mental health information on the web every year. Whether the information is needed for personal reasons or for a loved one, millions of mental health-related web pages are viewed. Sometimes the information found is authoritative, unbiased, and just what was needed. Other searches end in the retrieval of inaccurate, even dangerous, information.

How do you know whether the site you’re looking at presents valid, up-to-date information, or whether it is trying to sell you something, the rantings of a lunatic with an axe to grind, or otherwise bogus?

This article is intended to be a guide for you in your search for trustworthy information. It outlines the collective wisdom of medical librarians, mental health professionals, professional associations, and other experts who surf the web every day to discover quality information in support of clinical and scientific decision-making by professionals responsible for the nation’s mental health.

This is the first of a 2-part series. The information for today is presented under the following headings:

• What is the purpose of the site?
• Who owns the site? How is it funded?
• Be on guard for bias and competing interests
• Authorship and affiliation are important
• Authority and cited sources

Tomorrow’s installment, Part 2, will continue with the topics:

• How old is the information? When was it published or reviewed?
• Does the site support the doctor-patient relationship?
• Privacy, advertising, and other policies should be clearly stated
• How does the site interact with visitors?

What is the purpose of the site?

This is the first question you should ask. Is the site informational? Is it intended to sell you something? Is the author ranting about a pet peeve or an off-the-wall theory?

The website should clearly state whether the information is intended for the consumer or the health professional. Many health information websites have two different areas — one for consumers, one for professionals. The design of the site should make selection of one area over the other clear to the user.

This question is related to who runs and pays for the site. An “About This Site” link should be present on the site. If it’s not there, it should raise red flags. But if it’s there, use it. The purpose of the site should be clearly stated and should help you evaluate the trustworthiness of the information.

Anxiety, Panic & Health’s purpose is clearly stated in both the “About” and the “My Story” articles.

Who owns the site? How is it funded?

Any good health-related Web site should make it easy for you to learn who is responsible for the site and its information. and how it is funded.

Can you easily identify the site sponsor? Sponsorship is important because it helps establish the site as respected and dependable. Does the site list advisory board members or consultants? This may give you further insights on the credibility of information published by the site.

The web address itself can provide additional information about the nature of the site and the sponsor’s intent.

• A government agency or site sponsored by the Federal government has .gov in the address.
• An educational institution is indicated by .edu in the address.
• A professional organization such as a scientific or research society will be identified as .org. For example, the American Cancer Society’s website is http://www.cancer.org/.
• Commercial sites are most often identified by .com, and will identify the sponsor as a company, for example Merck & Co., the pharmaceutical firm.
• Non-commercial sites can be designated by .com, too, and also .net. The .com in the address is often chosen to make the site appear more professional or authoritative. Anxiety, Panic & Health has a .com address for these reasons.

The site should fully disclose the identities of commercial and noncommercial organizations that have contributed funding, services, or material to the site. Look for an “about us” page to check to see who runs the site. Know who is responsible for the content. Advertisements should be labeled. They should say “Advertisement” or “From our Sponsor.”

Anxiety, Panic & Health’s ownership and funding is stated in its “Funding and Advertising Policy” statement. Its advertisements are clearly labeled.

Be on guard for bias and competing interests

Nearly every author of every article ever written has an unspoken agenda that guides their writing. Psychologists, and even researchers, can be influenced by their background and education. Psychiatrists are often influenced by pharmaceutical marketing materials and their own medical training.

Educated internet users can use this understanding of an author’s motivations to help discern the value of information found online. A research news brief from the National Institute of Mental Health is likely to be less biased than a research news brief from a pharmaceutical company. A press release from a university describing some new therapy research will tend to be more biased than the actual peer-reviewed study.

Beware of sites selling products or services. A site selling Anxiety “cures” has an obvious bias, and any articles found there should be taken with a large grain of salt. A pharmaceutical company’s site may have a mix of factual articles, such as drug information, and articles biased in favor of their products. Someone selling their psychotherapy services online may subtly shape their articles (or links to other articles) to reflect a more pro-therapy stance. The key is to understand that this bias exists in many articles found online, and to use caution in relying on the information they provide.

Anxiety, Panic & Health’s “Funding and Advertising Policy” clearly states that I do not accept payment for reviews, favorable articles, or any other content that would potentially conflict with the editorial policies of this site or violate the trust of my readers. To minimize bias, every article is backed up with authoritative sources for all information.

Authorship and affiliation are important

Every page on the internet has been authored by someone, somewhere, at some specific time in the past. Unfortunately, most pages on most sites do not include this very basic information. Every article should name its author, the date it was written, and include information about the author, including affiliations. If there is no short biography or affiliations listed, look for an “about” page for this information.

If authorship and affiliation are not readily evident, the reader should question the validity of the article. Authorship also helps one determine possible bias in the article’s presentation of information.

Every Anxiety, Panic & Health article has the author and date clearly displayed at the head of the article. My biography and affiliations are in the “About” and the “My Story” articles. Other affiliations are listed under the sidebar heading,”Friendly Links.” Guest authors are clearly identified and have a short biography.

Authority and cited sources

One of the major points of contention raised by critics about blogging and online information is that it lacks filters. In other words, it is missing the editorial process: the fact checker correcting inaccurate information, the copy editor tweaking grammar, and the editor determining objectivity and relevance. In print publications, authority resides both in the identity of the author and with the publisher. This combination of individual and institutional authority lends the reader valuable clues about the credibility of the source material. This kind of authority is missing on the internet.

An important way to check the authority of mental health information online is to look for cited sources. Articles should have clinical research, authoritative articles and books, and other trustworthy sources of information as an integral part of the information provided. Every medical fact or figure should have references to back it up.

A person seeking mental health information online is seeking a balanced and authoritative understanding of the condition. However, this has become increasingly difficult because some websites and blogs blur the lines between facts and opinions. And sometimes we as readers tend to confuse facts with opinions — or emphasize one over the other — to the detriment of understanding.

If the article is the author’s opinion, it should be clearly stated. Opinions or advice should be clearly set apart from information that is “evidence-based” (that is, based on research results). Beware of articles that do not offer external medical evidence to back up their claims, or that do not make it clear that the opinion or advice offered is personal.

Anxiety, Panic & Health’s articles always have resources listed, and in the case of medical information every fact and figure is footnoted or backed up by an authoritative source. Opinion articles are clearly categorized as such. This is especially important, since I am not a mental health professional, as stated in my “Disclaimer.”

Don’t miss tomorrow’s installment!

Tomorrow’s installment, Part 2, covers important topics that you are sure not to want to miss. It will continue with the topics:

• How old is the information? When was it published or reviewed?
• Does the site support the doctor-patient relationship?
• Privacy, advertising, and other policies should be clearly stated
• How does the site interact with visitors?

What do you think?

Searching for reliable mental health information on the web can be a very frustrating experience. Often a source that seems promising turns up to be promoting a product or a theory that is unproved and unprovable. Search long enough and you will even run into rampant plagiarism of articles from one bad source to another!

• What is your experience of searching the internet for medical or mental health information?
• Have you ever been frustrated by the volume of unreliable sites?
• Do you have an opinion about the trustworthiness of commercial sites?

©2009 Michael L Nichols. All rights reserved.

Resources used in this post:
Grohol, John M. (2007, January 11). Reliability and Validity in a Web 2.0 World. Retrieved June 25, 2008 from Psych Central web site.
Grohol, John M. (2007, December 4). Evaluating the Quality of Mental Health Websites. Retrieved June 25, 2008 from Psych Central web site.
Kroski, Ellyssa. (2006, February 20). Authority in the Age of the Amateur. Retrieved October 21, 2008 from Infotangle web site.
Medical Library Association. (2008, July 25). A User’s Guide to Finding and Evaluating Health Information on the Web. Retrieved October 27, 2008 from Medical Library Association web site.
Medline Plus. (2006, February 13). Medline Plus Guide to Healthy Web Surfing. Retrieved October 27, 2008 from Medline Plus web site.
National Cancer Institute. (2005, September 1). How to Evaluate Health Information on the Internet: Questions and Answers. Retrieved October 27, 2008 from National Cancer Institute web site.
National Center for Complementary and Alternative Medicine. (2008, August 27). 10 Things to Know About Evaluating Medical Resources on the Web. Retrieved October 27, 2008 from National Center for Complementary and Alternative Medicine web site.
National Institute on Aging. (2005, August). Health Quackery: Spotting Health Scams. Retrieved October 27, 2008 from National Institute on Aging web site.
Schloman, Barbara F. (2002, December 16). Information Resources: Quality of Health Information on the Web: Where Are We Now? Retrieved October 27, 2008 from The Online Journal of Issues in Nursing web site.
Winker, Margaret; Flanagin, Annette; Chi-Lum, Bonnie; White, John; Andrews, Karen; Kennett, Robert; DeAngelis, Catherine; Musacchio, Robert. (2008, August 1). Guidelines for medical and health information sites on the Internet. Retrieved October 22, 2008 from American Medical Association web site.