I think you're misunderstanding the self-report here. The people are "self-reporting" their depression/anxiety by filling out well verified and validated assessment forms. These are routinely used by psychiatrists and psychologists, and there's really no reason to believe that the data collected from these should be discounted.

Nope. They used the EQ-5D questionaire.

"We utilized the EQ-5D to investigate self-reported depression and anxiety in a community sample." Pg. 4 of 17.

These EQ-5D is a common survey tool for initial visits of potential patients. It is known to be inaccurate because it is filled out by people who isn't trained in this field, they just need help. That's why they came.

Your point about physician effects- the people being referred to physicians are people who are experiencing clear clinical depression symptoms; my guess would be meeting requirements for moderate or severe clinical depression, which was likely assessed using the surveys you mentioned earlier. What they're saying with the quote you picked out is that if the study intervention wasn't enough to monitor them closely enough, they weren't included in the study and they were instead referred to a family physician.

No. This is literally all that the study says. "Any participant with obvious clinical depression or anxiety who requires closer monitoring or psychiatric medications is referred to their family physician"

You are injecting additional dialogue that didn't exist.

The people you're referring to that dropped out didn't actually drop out. If you actually read the study, they mention that they only included the 4k participants in a comparison between baseline and one year because these people came back to the clinic during a specified time frame (within 6-18 months). The rest of the people who you mentioned "dropped out" just didn't come back for a followup visit during this time frame, and so they weren't included in this analysis. Even if all those people did opt out of the study, high rates of attrition for a sample this large is relatively normal, and a sample of 4,000 people is still a really robust sample. There's no reason to doubt results purely based on this.

If you did not come back within specified time frame (6-18months), then it cannot be counted. That is the medthodology and it is set up that way. I don't have a problem with drop outs. I have a problem when most participants drop out as it's a sign that you didn't design your study properly, which in this case, it is.

This sort of ties into my point above. The discrepancy between the 7k participants you mention and the 4k in the follow-up analysis is because not all people in the study returned for a followup visit during a specified time frame. The 4k number you keep referencing is because they specifically conducted a comparison between baseline and a one year followup. Not all people returned within a year, so not all people were included in this analysis.

I was right. There is a huge discrepancy. The data is literally called "Change in Reported Level of Depression and Anxiety at One Year"

Do not tell me that the participants comes back after over 18 months and then still count it as the year mark. You cannot allow participants to come back 2 years later to report their 1 year result either. That is improper methodology.

I don't have time to keep replying to every comment and bust every misleading post. I hope you learn to properly read and conduct a research paper if you are really a grad student.