Sunday, July 28, 2019

It's all in your body, mind or soul: causal attributions for depression

Given how depression can manifest in different ways, and the multiple methods of intervention from talk therapy to pharmacological to lifestyle change to ECT, it is hardly surprising that people hold mixed opinions on where depression "comes from", and what the best choices are for help-seeking and therapeutic intervention.

A cool new study employed an online survey platform to run an experimental study of how different vignettes emphasising different causal attributions for depression might affect attitudes towards intervention, both in terms of help-seeking and treatment options. Although lifestyle interventions or psychotherapeutic treatment were generally preferred to medical intervention, a vignette that emphasised biological attributions (compared to social or biopsychosocial attributions) for depression reduced the perceived efficacy of less biological treatments

The results suggest that encouraging a less Cartesian, body OR mind understanding of the etiology of depression might affect attitudes towards different intervention modalities. Such an approach may help to overcome ethical concerns the authors raise of "manipulating" patient's attitudes/causal attributions towards major depression. Of course, it can be easier to say this than it is to achieve it, when it is so easy to lapse into traps such as, for example, using phrases like "medical treatment" to mean pharmacological treatment, even though many physicians prescribe things like exercise or going to a therapist for cognitive behavioural therapy.  

Interestingly, a clear majority of respondents to the online survey reported a history of major depression. Those with a personal history tended to rate a more medical approach to treatment more highly than people with no personal history of depression. Having a high proportion of respondents with a personal history of depression is not unusual or surprising, particularly as the study was advertised as examining treatment preferences for depression. It might nonetheless be interesting to see whether one would observe similar results in a large cohort of more clearly "naive" respondents (e.g. with no personal history of depression or history of depression in family/close friends, and who report no training/particular interest in major depression).

Nolan, A. & O'Connor, C. (2019). The Effect of Causal Attributions for Depression on Help-Seeking and Treatment Preferences. Journal of Affective Disorders, 257, 477-485.

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