From the inside: Depression & the Cognitive Disorder

[LSW]

In July 2008 I was diagnosed as depressive by the VA (Veterans Administration).

 

If you watch TV, you have seen the commercials for some medication describing the physical results of depression. Depression is however a form of Cognitive Disorder and effects how you use the internet as well as how you see the world. So this is meant as a first person look at my experience surfing the internet. I will also mention is passing how it effects me as a web developer.

 

Concentration - One thing I have noticed over the last year or so is an increasing inability to concentrate. This goes for both coding web sites as well as using them. When I am supposed to code something that is a bit more complicated or when I come across complicated /abstract ideas in web sites it is as if I hit a wall and deflect to something "easier." I must forcibly attempt to concentrate and any outside activities easily break my concentration and offer me an escape from what I am trying to understand. I find myself repeatedly reading content and vocally speaking it in an attempt to focus and understand it.

 

Comprehension - This ties in with concentration. Again it is an inability to understand what I am reading. With other accessibility issues, there are ways of doing things, tools, assistive technologies etc. to help us. But there are no tools or tricks to assist those of us with difficulties understanding what is being said, that makes Cognitive disorders a real gray area for developers. Even when I manage to concentrate for any length of time, it does not mean I understand what I read.

 

As a team member developing an application, I sit in on meetings and I watch their lips move, I hear the words and my even understand in that moment... but it is lost by the time the meeting is over. Programming is in a large extent dealing with sometimes very abstract ideas and ways of thinking.

As a user it means I may not understand content. I have other personal issues currently and visited a section of the state of Alaska's web site for help in dealing with these issues. I read for an hour, followed links and in the end I was nowhere. The sheer number of links and the "Official" sounding names of programs and then the dry techno speak and mass of information I was frustrated, irritable and simply exited the site without the info I need to help my family. These sites and programs exist for people who need help, yet when I and who knows how many others go to the site to get that help, we are already under stress, we are already troubled and maybe in a hurry... and therefore we need the info to be easily understandable and easily found and not further frustrate us with techno speak and information avalanches.

 

Memory - Another symptom is memory loss. This is another area that spans coder and user. I was directed to do something easy, something really anyone with web development experience could do and in the time it took to turn to my PC I lost what I was to do and had to have it explained 3 times before I finally got it. I have found myself unable to recall code when asked for help on subjects of CSS, HTML and Accessibility. As a user it makes it hard to recall what is written. A telephone number, a name, the meaning of an abbreviation explained early on in the web site. I have printed more web pages of late then ever before so I have it in hard copy on file somewhere so I don't have to try to find them again.

 

Problem solving - Another area of difficulty is the ability to solve problems. The easy example is in the web forums I visit where I am one of those regulars who help often. I have begun to avoid any threads asking help with solving code problems. This is a partial mix of the above, concentration, comprehension and memory. As a user, any time we visit a web site is is an issue of problem solving. This is the info I need/want, how to I get it and how do I use it? Problem solving is more an issue for me as a programmer... but when a user is faced with many links that may be considered somewhat vague, they may not see clearly what path they may need to take to get where they wish to be. Open an advanced book on mathematics, imagine someone stopping you on the street and showing you a formula and asking you to explain it, that is sort of how I feel now when I surf, I hit some complicated content and get a brain freeze as if it was a formula from Einstein.

 

Restlessness & agitation - This results in an inability to sit still and search in depth for the information one needs. If the information is not easily and quickly found an increased restlessness makes it increasingly difficult to sit through a myriad of deeply buried links or to thoroughly read the content.

 

So that is a quick look at the issues I now face when dealing with the internet. How will you the developer now handle them? Will you need to? Well I did a quick statistics search and this is what I found:

 

Depression-Guide.com

• Approximately 18.8 million American adults, or about 9.5 percent of the U.S. population age 18 and older in a given year, have a depressive disorder.
  
• Nearly twice as many women (12.0 percent) as men (6.6 percent) are affected by a depressive disorder each year. These figures translate to 12.4 million women and 6.4 million men in the U.S.
  
• Major depressive disorder is the leading cause of disability in the U.S. and established market economies worldwide.
  
• Major depressive disorder affects approximately 9.9 million American adults, or about 5.0 percent of the U.S. population age 18 and older in a given year.
  
• Nearly twice as many women (6.5 percent) as men (3.3 percent) suffer from major depressive disorder each year. These figures translate to 6.7 million women and 3.2 million men.
  
• While major depressive disorder can develop at any age, the average age at onset is the mid-twenties.
  

 

UpliftProgram.com

• Depressive disorders affect approximately 18.8 million American adults or about 9.5% of the U.S. population age 18 and older in a given year. This includes major depressive disorder, dysthymic disorder, and bipolar disorder.
  
• Everyone, will at some time in their life be affected by depression -- their own or someone else's, according to Australian Government statistics. (Depression statistics in Australia are comparable to those of the US and UK.)
  
• The rate of increase of depression among children is an astounding 23% p.a.
  
• 15% of the population of most developed countries suffers severe depression.
  
• 30% of women are depressed. Men's figures were previously thought to be half that of women, but new estimates are higher.
  

 

 

So as you see almost 19 Million potential users of your or your customers web site have depression like me. They may have the same problems using a site as I have. This also does not include other cognitive disorders, these are only depression, so these numbers may only be a fraction of those with other cognitive disorders that affect the user the same way. Some 5.7 Million in the US are Bipolar and worldwide 222 Million. As many as 5.2 million people in the United States are living with Alzheimer?s and an estimated 10 Billion baby boomers will have it in their life time. Then there are immigrants who may not speak/read your language fluently and therefore will have issues understanding terminology heavy web sites.

 

The National Institute of Mental Health (NIMH) states:

"Mental disorders are common in the United States and internationally. An estimated 26.2 percent of Americans ages 18 and older ? about one in four adults ? suffer from a diagnosable mental disorder in a given year. When applied to the 2004 U.S. Census residential population estimate for ages 18 and older, this figure translates to 57.7 million people. Even though mental disorders are widespread in the population, the main burden of illness is concentrated in a much smaller proportion ? about 6 percent, or 1 in 17 ? who suffer from a serious mental illness. In addition, mental disorders are the leading cause of disability in the U.S. and Canada for ages 15-44. Many people suffer from more than one mental disorder at a given time. Nearly half (45 percent) of those with any mental disorder meet criteria for 2 or more disorders, with severity strongly related to comorbidity."

 

So it is up to you the developer/owner to decide if you will recognize the issue and add it to the list of things to consider when creating an accessible web site. You will never make a web site that is right for everyone... but you can make it easier for us.

 

Balance the need for "professionalism" with the need of the user. We all want to look professional, but the language you use may not be the best for someone with an comprehension or concentration problem.

 

Be sure to make the web page printable if it is complicated or carries info that is complicated or abstract that a person may need to remember. Repeat important abbreviation/acronym/term definitions throughout the site so the user who may have memory issues need not jump back and forth.

 

Make navigation simplistic and shallow. Make it logical of course, but try not to bury things to deeply and use link names that are easily to understand and remember.

 

Offer alternatives. If you need content that is very terminology heavy, have a link with much more basic content that will give us a brief idea and then we can try the more complicated content if needed. Some people may understand a table of data, another may do better with the information displayed in a paragraph or three. Some may understand the written word better and others may prefer a video or audio explanation of the info.

 

I will not suggest you dumb web sites down to a 3rd grade intelligence like commercials do. But read your content and ask yourself, is it really clear? Do I really need to use these words? Is it to abstract? Could I not write it a little simpler or show more examples and more graphics to support the written word? Is my navigation to deep? Do I need hundreds of links on the index page? What can I do to make it easier to understand and use?

 

We don't have any easy tools to help us with this and I have no assistive technology to help me understand. All I have is the effort you put into it... for those like me, simple is better.

[LSW]