Citation misrepresentation Melissa Raven, Flinders University 20 April 2010 Wright et al. claim that for mood disorders and psychosis in young people, 'early detection and treatment at the time of first onset has been found to improve long-term outcome and reduce the risk of future episodes of illness'. Two references (15 and 18) are cited in relation to depression. Reference 15 (Kupfer et al. 1989) is a study of 45 people with at least three episodes of unipolar depression (median 4). Kupfer et al. commented that it might not be valid to generalise the findings to unipolar depression more broadly. Participants had a mean age of 42.7 years. So this was not a study of early detection and treatment of first onset depression, nor a study of young people. Furthermore, the study was undertaken at a university department of psychiatry, further reducing the generalisability to depressed patients in general. Reference 18 (Kroll et al. 1996) is a study of 17 depressed adolescent patients who received continuation CBT after remission. They were compared with 12 historical controls (also depressed adolescent patients) who did not receive the continuation CBT. All were patients treated at a depression clinic in a university hospital, again an unrepresentative group. They were followed up for only 6 months. So again this was not a study of early detection and treatment. Furthermore, it was a small, methodologically weak study with a short follow-up period. Neither study supports Wright et al.'s claim that early detection and treatment of first-onset depression improves long-term outcomes and reduces the risk of future episodes. This is a clear case of citation misrepresentation. Furthermore, Wright and all but one of her co-authors made a very similar claim in a 2005 paper , which has been cited almost verbatim ('Early detection and treatment have been shown to improve long-term outcomes and reduce the risk of future episodes of mental health disorders (Wright et al 2005)') in draft Australian national guidelines for treatment of depression in young people . This is an example of how citation distortions can generate 'information cascades resulting in unfounded authority of claims' . 1. Wright A, Harris MG, Wiggers JH, Jorm AF, Cotton SM, Harrigan SM, Hurworth RE, McGorry PD. Recognition of depression and psychosis by young Australians and their beliefs about treatment. Med J Aust. 2005 Jul 4;183(1):18-23. [http://www.mja.com.au/public/issues/183_01_040705/wri10870_fm.html] 2. beyondblue: the national depression initiative. DRAFT Clinical practice guidelines: Depression in adolescents and young adults. March 2010. [http://www.beyondblue.org.au/index.aspx?link_id=6.1245]. 3. Greenberg SA. How citation distortions create unfounded authority: analysis of a citation network. BMJ 2009 Jul 20;339:b2680. doi:10.1136/bmj.b2680. [http://www.bmj.com/cgi/content/full/339/jul20_3/b2680] Competing interests I am a member of Healthy Skepticism.