Does framing depression as an adaptation to one's environment, rather than as a disease, result in better patient outcomes?
Explaining to patients that their depressive symptoms are an adaptation to their current circumstances, rather than as a "disease like any other," may produce less stigma and greater patient acceptance and self-efficacy. It may be time we all start thinking of depression as a signal that something in a patient's life needs more attention and not as something endogenous; this approach opens up the toolbox. The "chemical imbalance" explanation of depression, if true at all, may be the effect and not the cause. 1b-
Plan de l'etude:
Randomized controlled trial (nonblinded)
"You have a chemical imbalance in your brain" is a common way to explain depression to patients. Although this explanation may decrease a patient's self-blame, it may also reduce their sense of hope for recovery, as well as stigmatize them or others with the "disease" of depression. It also may fail to get at the real explanation of depression for some — as an adaptation to the life situation in which they find themselves. This study enrolled 877 participants who had a history of depression (average Patient Health Questionnaire depression scale score 10.51) but had not been treated with psychotherapy or prescribed medication by a psychiatric specialist. The researchers' goal was to find people with depression who had not received the "depression is a disease" explanation, which is odd, since they allowed participation even if treated for depression by a primary care clinician (and what is even odder, they called these patients "treatment naive"). Using concealed allocation, participants were randomized to receive 1 of 2 descriptions of depression in a series of videos. One set of videos explained that depression is a disease caused by a variety of factors, including a chemical imbalance in the brain. The other set explained that depression was a functional signal that alerts the individual that something in his or her life needs more attention. There was a small benefit to the "depression as a signal" explanation in terms of participants' positive beliefs that they could overcome their depression (P = .02) and that depression is an adaptive response that can lead to new insights (P < .0001), and there was less stigma associated with mental illness in this group (P = .026). There was no difference in attitudes toward seeking help for depression, the participants feeling of responsibility for their symptoms, or indicators of a growth mindset toward depression. The effect sizes for the significant results were small, and it is possible that patients, either through their previous treatment experience or by consulting "Dr Google," were steeped in the depression-is-a-disease model.
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine