How adults with suspected depressive disorder experience online depression screening: A qualitative interview study

Background: While evidence on the effects and mechanisms of online depression screening is inconclusive, publicly available 'online depression tests' are already frequently used. To further a comprehensive under-standing of online depression screening and evince the perspectives of those affected, we aimed to qualitatively explore how adults with undiagnosed but suspected depressive disorder experience the screening process.Methods: This study is a qualitative follow-up of a German-wide, 3-arm, randomised controlled trial on feedback after online depression screening conducted between Jan 2021 and Sep 2022. A subsample of 26 participants with undiagnosed but suspected depressive disorder (Patient Health Questionnaire-9 >= 10; no depression diagnosis/treatment within the last year) were purposefully selected based on maximum variation in gender, age, and study arm. In-depth semi-structured telephone interviews (mean = 37 min) were conducted approximately six months after screening. Data were analysed within a contextualist theoretical framework using inductive reflexive thematic analysis.Results: Participants were balanced in terms of gender (female/male, n = 15/11), age (range = 22 to 61 years), and study arm (no feedback/standard feedback/tailored feedback, n = 7/11/8). Reported experiences of online depression screening can be described as a two-step process: Step 1 is the initial reaction to the screening procedure and comprises the theme recognition of depressive symptoms: from denial to awareness. Step 2 describes a subsequent self-explorative process encompassing the themes cognitive positioning: rejection vs. acceptance, emotional reaction: between overload and empowerment, and personal activation: from reflection to action.Conclusions: Findings indicate that online depression screening with and without feedback of results is experi-enced as a two-step process promoting symptom recognition and subsequent self-exploration. While few par-ticipants reported negative effects, the majority described the screening process as insightful, empowering, and activating. Future research should determine to what extent online depression screening may pose a standalone form of low-threshold support for individuals with undiagnosed depressive disorder, while focusing as well on potential negative effects.