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Schroder HS, Russman Block S, Moser JS. Chemical imbalance and etiological beliefs about depression among college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:1993-2000. [PMID: 35834783 DOI: 10.1080/07448481.2022.2098037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
Etiological beliefs of depression have differing impacts on motivation, hope, and treatment expectations. However, it is unclear where people are exposed to these beliefs. Objective: This study examined beliefs about depression and their relations to symptoms, attitudes about depression, and treatment preferences. Participants: 426 undergraduates attending a large midwestern university. Methods: Participants completed an online survey asking about causes of depression, if and where they had heard about the "chemical imbalance" explanation of depression, attitudes about depression, as well as measures of their symptoms, treatment history, and hypothetical treatment preferences. Results: Sixty-two percent of the sample had heard of the chemical imbalance explanation, most commonly from the classroom. Biochemical beliefs about depression were most strongly endorsed among participants with a family history of depression and who had had personal experience with treatment. The chemical imbalance belief was uniquely related to dysfunctional beliefs about depression. Etiological beliefs were largely unrelated to treatment preferences. Conclusion: College students are exposed to models of mental health that may not be ideal for treatment and recovery.
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Affiliation(s)
- Hans S Schroder
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Stefanie Russman Block
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jason S Moser
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
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Aggarwal NK, Sadaghiyani S, Kananian S, Lam P, Messner G, Marincowitz C, Narayan M, Luciano AC, van Balkom AJLM, Hezel D, Lochner C, Shavitt RG, van den Heuvel OA, Simpson B, Lewis-Fernández R. Patient Perceptions of Illness Causes and Treatment Preferences for Obsessive-Compulsive Disorder: A Mixed-Methods Study. Cult Med Psychiatry 2024; 48:591-613. [PMID: 38898162 DOI: 10.1007/s11013-024-09865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
Obsessive-compulsive disorder (OCD) is a condition with high patient morbidity and mortality. Research shows that eliciting patient explanations about illness causes and treatment preferences promotes cross-cultural work and engagement in health services. These topics are in the Cultural Formulation Interview (CFI), a semi-structured interview first published in DSM-5 that applies anthropological approaches within mental health services to promote person-centered care. This study focuses on the New York City site of an international multi-site study that used qualitative-quantitative mixed methods to: (1) analyze CFI transcripts with 55 adults with OCD to explore perceived illness causes and treatment preferences, and (2) explore whether past treatment experiences are related to perceptions about causes of current symptoms. The most commonly named causes were circumstantial stressors (n = 16), genetics (n = 12), personal psychological traits (n = 9), an interaction between circumstantial stressors and participants' brains (n = 6), and a non-specific brain problem (n = 6). The most common treatment preferences were psychotherapy (n = 42), anything (n = 4), nothing (n = 4), and medications (n = 2). Those with a prior medication history had twice the odds of reporting a biological cause, though this was not a statistically significant difference. Our findings suggest that providers should ask patients about illness causes and treatment preferences to guide treatment choice.
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Affiliation(s)
- Neil Krishan Aggarwal
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, USA.
- New York State Psychiatric Institute, New York, USA.
| | | | - Schahryar Kananian
- Department of Clinical Psychology and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Peter Lam
- New York State Psychiatric Institute, New York, USA
| | | | - Clara Marincowitz
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa
| | - Madhuri Narayan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Alan Campos Luciano
- Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Anton J L M van Balkom
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- GGZ inGeest, Amsterdam, The Netherlands
| | - Dianne Hezel
- New York State Psychiatric Institute, New York, USA
| | - Christine Lochner
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa
| | - Roseli Gedanke Shavitt
- Obsessive-Compulsive Spectrum Disorders Program, LIM-23, Instituto de Psiquiatria do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Odile A van den Heuvel
- Department of Psychiatry, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Anatomy and Neuroscience, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Compulsivity Impulsivity Attention Program, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Blair Simpson
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, USA
- New York State Psychiatric Institute, New York, USA
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York, USA
- New York State Psychiatric Institute, New York, USA
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Aggarwal NK. Pharmaceuticalization and Care Coordination in New York City Outpatient Mental Health. Med Anthropol 2024; 43:383-396. [PMID: 39037498 PMCID: PMC11306980 DOI: 10.1080/01459740.2024.2378092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
US government quality measures prioritize pharmaceuticalization and care coordination to promote patient treatment adherence. How these measures affect outpatient mental health service delivery and patient-provider communication where psychiatrists and nonphysicians collaborate is understudied. Analyzing 500 hours of participant-observation, 117 appointments, and 98 interviews with 45 new patients and providers, I show that psychiatrists and social workers coordinated care by encouraging medications and seeing two mental health providers as the default treatment, irrespective of patient preferences. Ethnographic perspectives crucially account for models of service delivery and provider behaviors in researching treatment adherence.
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Affiliation(s)
- Neil Krishan Aggarwal
- Columbia University and the New York State Psychiatric Institute, New York, New York, USA
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Fellin LC, Zizevskaia E, Galbusera L. Is the mainstream construction of mood disorders resistant to systemic thinking? Front Psychiatry 2024; 14:1270027. [PMID: 38323024 PMCID: PMC10846429 DOI: 10.3389/fpsyt.2023.1270027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/22/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction In this study we explore how the diagnostic category of mood disorders is constructed in two handbooks of Psychopathology as an example of the mainstream construction of psychopathology. Despite the increasing criticism and lack of evidence, the debunked chemical imbalance theory of the etiology of depression still dominates the professional and pop/folk understanding and interventions. Methods We analysed the breadth of the inference field and the type of etiopathogenetic contents of the explanations of mood disorders using the "1to3" Coding System. Results Our findings show that the dominant explanations draw almost exclusively onto monadic explanations, followed by limited dyadic ones. Intrapersonal etiopathogenetic contents prevailed, and biomedical explanations were dominant in both textbooks. Discussion We critically discuss the underpinnings of these results and address the clinical implications of these biased representations, as well as potential alternative approaches to psychopathology.
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Affiliation(s)
- Lisa C. Fellin
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | | | - Laura Galbusera
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Brandenburg, Germany
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Buchman DZ, Imahori D, Lo C, Hui K, Walker C, Shaw J, Davis KD. The Influence of Using Novel Predictive Technologies on Judgments of Stigma, Empathy, and Compassion among Healthcare Professionals. AJOB Neurosci 2024; 15:32-45. [PMID: 37450417 DOI: 10.1080/21507740.2023.2225470] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Our objective was to evaluate whether the description of a machine learning (ML) app or brain imaging technology to predict the onset of schizophrenia or alcohol use disorder (AUD) influences healthcare professionals' judgments of stigma, empathy, and compassion. METHODS We randomized healthcare professionals (N = 310) to one vignette about a person whose clinician seeks to predict schizophrenia or an AUD, using a ML app, brain imaging, or a psychosocial assessment. Participants used scales to measure their judgments of stigma, empathy, and compassion. RESULTS Participants randomized to the ML vignette endorsed less anger and more fear relative to the psychosocial vignette, and the brain imaging vignette elicited higher pity ratings. The brain imaging and ML vignettes evoked lower personal responsibility judgments compared to the psychosocial vignette. Physicians and nurses reported less empathy than clinical psychologists. CONCLUSIONS The use of predictive technologies may reinforce essentialist views about mental health and substance use that may increase specific aspects of stigma and reduce others.
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Affiliation(s)
- Daniel Z Buchman
- Centre for Addiction and Mental Health
- Dalla Lana School of Public Health, University of Toronto
- University of Toronto Joint Centre for Bioethics
| | | | - Christopher Lo
- Dalla Lana School of Public Health, University of Toronto
- Temerty Faculty of Medicine, University of Toronto
- College of Healthcare Sciences, James Cook University, Singapore
| | - Katrina Hui
- Centre for Addiction and Mental Health
- Temerty Faculty of Medicine, University of Toronto
| | | | - James Shaw
- University of Toronto Joint Centre for Bioethics
- Temerty Faculty of Medicine, University of Toronto
| | - Karen D Davis
- Temerty Faculty of Medicine, University of Toronto
- Krembil Brain Institute, University Health Network
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McCradden M, Hui K, Buchman DZ. Evidence, ethics and the promise of artificial intelligence in psychiatry. JOURNAL OF MEDICAL ETHICS 2023; 49:573-579. [PMID: 36581457 PMCID: PMC10423547 DOI: 10.1136/jme-2022-108447] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 11/29/2022] [Indexed: 05/20/2023]
Abstract
Researchers are studying how artificial intelligence (AI) can be used to better detect, prognosticate and subgroup diseases. The idea that AI might advance medicine's understanding of biological categories of psychiatric disorders, as well as provide better treatments, is appealing given the historical challenges with prediction, diagnosis and treatment in psychiatry. Given the power of AI to analyse vast amounts of information, some clinicians may feel obligated to align their clinical judgements with the outputs of the AI system. However, a potential epistemic privileging of AI in clinical judgements may lead to unintended consequences that could negatively affect patient treatment, well-being and rights. The implications are also relevant to precision medicine, digital twin technologies and predictive analytics generally. We propose that a commitment to epistemic humility can help promote judicious clinical decision-making at the interface of big data and AI in psychiatry.
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Affiliation(s)
- Melissa McCradden
- Joint Centre for Bioethics, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Genetics & Genome Biology, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Katrina Hui
- Everyday Ethics Lab, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Z Buchman
- Joint Centre for Bioethics, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Everyday Ethics Lab, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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