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“But how are you really?” Eliminating the ‘Fake-Good’ response



‘How are you?’ is a common question, so common it can at times seem trivial, but in the grips of COVID-19 this common question seeks to uncover more than it ever has before.


Asking how people are feeling is an important component of research with many far-reaching implications, so it is imperative that such questions are asked in the right way to obtain the most accurate answers. In our recently published article in the Australian Journal of Psychology (Measuring psychological distress among Australians using an online survey, Klein, Tyler-Parker, & Bastian, 2020) we examined whether responses to the Kessler Psychological Distress Scale (K10) – a popular measure of psychological distress to identify people in need of further assessment or support for anxiety and depression – could be influenced by whether questions are asked online or face-to-face. The difference in reported levels of psychological distress by situation was huge a significant finding for assessments of people’s emotional and mental wellbeing, such as the Australia’s National Health Survey, which includes the K10 questions and is asked exclusively face-to-face.


Pollinate’s online study (2018) revealed that participants who answered the K10 questions online were four times more likely to report high or very high levels of psychological distress than respondents asked face-to-face in the 2017-18 National Health Survey, conducted by the Australian Bureau of Statistics (ABS); the difference was even higher among Australians under 34 years. The significant difference in responses shows the importance of research design on research outcomes, and highlights the need to consider the participant’s environment when conducting research.


The Kessler Psychological Distress Scale asks very personal questions of the participant such as: ‘In the past 4 weeks about how often did you feel so sad that nothing could cheer you up?’ and, ‘how often did you feel worthless?’ With such probing questions, it is easy to comprehend how answering these questions in a face-to-face, or even telephone interview could produce a tendency to ‘fake good’. These findings, alongside similar results from existing studies, implies that implementing anonymous and interviewer-free environments, (delivered by an online approach for example) may help researchers to uncover more truthful responses to sensitive topics.


Following on from a harrowing summer of drought and fire, the COVID-19 pandemic has been referred to as a driver of anxiety, depression and grief. It is now more important than ever to accurately understand, measure and report people’s mental health to ensure Australians get the support they need.


If the ABS were to continue to conduct the National Health Survey face-to-face, while they would likely see an increase in K10 scores that reflect the stress people have experienced in 2020, our research shows this level of psychological distress would be significantly under reported. The implications of under-reporting such a metric as the nation’s level of psychological distress are far reaching, as is the concern that K10 scores may have been systematically under-estimated for years.


All of this leads us to ask while face‑to‑face interviewing may have once been the gold standard, is there a more important time than now to discover whether a better method exists?


To read the full article:

Measuring psychological distress among Australians using an online survey


For coverage in InPsych:

Is psychological distress among Australians underestimated?


Other references:

Anxiety on rise due to coronavirus, say mental health charities

Experts explain how to manage mental wellbeing during COVID-19

COVID-19 could lead to an epidemic of clinical depression

That Discomfort You’re Feeling Is Grief


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