Biological conceptualizations of mental disorders among affected individuals: A review of correlates and consequences

Causal beliefs about mental illness: A scoping review

Research on causal beliefs about mental illness-the beliefs people hold about what causes a particular mental illness, or mental illnesses in general-is split across a number of theories and disciplines. Although research on this subject has provided a number of insights and practical applications, the diversity of theories, terminology, and keywords makes it challenging for a new reader to gain a comprehensive understanding. We sought to address this by conducting a systematic scoping review of research on causal beliefs. This review included English-language articles from any year that mentioned causal beliefs for mental illness in their title or abstract. We identified articles in two stages. In the first stage, we used a narrow set of search terms referring specifically to causal beliefs (1227 records identified, 417 included). In the second stage, we used a comprehensive set of terms relevant to research on causal beliefs (10,418 records identified, 3838 included). We analyzed articles qualitatively, organizing them into one of five theories or categories: the common-sense model of self-regulation, explanatory models, mental health literacy, biogenetic causal beliefs, and other research on causal beliefs. We provide a comprehensive summary of these literatures in terms of their history, typical research questions and study design, findings, and practical applications. These theories differ in their theoretical orientation towards causal beliefs, research methods, findings, and applications. However, they broadly share a view of causal beliefs as multifaceted, culturally determined, and relevant for additional psychosocial variables such as mental illness stigma and help-seeking. We conclude by making recommendations for researchers, clinicians, public health messaging, and for individuals with mental illness.

Framing Effects of Cognitive Behavioural Therapy for Depression on Perceptions of Believability, Acceptability, and Credibility

While CBT is an effective treatment for depression, uptake can be low. This is largely due to attitudinal barriers. Accordingly, the goals of the current investigation were to (a) tailor and develop persuasive psychoeducational materials to match dominant cultural beliefs about the causes of depression and (b) examine the effectiveness of tailored CBT descriptions in improving CBT perceptions. We examined the believability of CBT mechanisms by invoking commonly endorsed etiological models of depression and investigated whether tailoring CBT descriptions to match etiological beliefs about depression influences perceptions of CBT. Participants were recruited using TurkPrime. In Study 1, participants (n = 425) read a CBT description that was generic or framed to match an etiological model of depression (biological, stress/environmental, or relationship/interpersonal). The participants indicated believability of each model as adopted by CBT. In study 2, the participants (n = 449) selected what they believed was the most important cause of depression. Subsequently, the participants were randomised to receive either a CBT description tailored to their endorsed model or a generic CBT description, and they provided ratings for CBT's acceptability, credibility, and expectancy. In Study 1, the believability of biological CBT mechanisms was low across conditions, but participants reported greater believability when receiving a biological description than when receiving other mechanistic descriptions. Participants who received the stress- and relationship-focused descriptions did not rate the respective models as more believable than those who received a generic description. In study 2, there were no differences in the perceptions of acceptability, credibility and expectancy between participants who received a tailored description and those who received a generic description. Our findings suggest that CBT is believed to be a psychologically appropriate treatment; however, the believability of biological mechanisms is improved by presenting a biology-focused description.

Explanatory models of mental illness among working professionals diagnosed with bipolar or depression in the United States

BACKGROUND

People diagnosed with mental illness develop a variety of explanatory models of their conditions in the face of uncertainty. Explanatory models matter because they are associated with internalized stigma and illness behaviors such as treatment preferences.

AIMS

This paper explores how working professionals in the United States draw on biological and/or environmental factors to explain the cause(s) of their diagnoses of bipolar or depression.

METHOD

Findings are derived from an analysis of transcripts of in-depth interviews with 52 individuals from across the United States who were invited to participate in a study of working professionals diagnosed with mental illness. About 25 self-identified as having bipolar disorder and 27 as having major depression. Transcript data were analyzed following the principles of flexible coding with the goal of establishing a typology of explanatory models of self-identified bipolar versus depression.

RESULTS

Six types of explanatory models emerged from the analysis. One was exclusively biological, a second was exclusively environmental, and the remaining four combined biological and environmental factors in different ways. Quotations from the interviews are provided to illustrate each type, and comparisons between types are made based on primary diagnosis (bipolar vs. depression), and self-reports of trauma and stressful experiences.

CONCLUSION

Implications for the future research on explanatory models and how they may impact people who are diagnosed with a mental illness across multiple dimensions of their lives are presented.

Impact of alternative terminology for depression on help-seeking intention: A randomized online trial

OBJECTIVE

People with depression experience barriers to seeking professional help. Different diagnostic terminology can influence people's treatment/management preferences. The aim of this study was to investigate how alternative depression diagnostic labels and recommendations impact help-seeking intentions and psychosocial outcomes.

METHODS

Participants (18-70 years) were recruited using an online panel (Australia) to complete a randomized controlled trial. They read a hypothetical scenario where they discussed experiencing depressive symptoms with their GP and were randomized to receive one of four diagnoses ("depression," "burnout," "functional impairment syndrome" [fictitious label], no label [control]), and one of two follow-up recommendations ("clinical psychologist," "mind coach").

PRIMARY OUTCOME

help-seeking intention (5-point scale, higher = greater intention); secondary outcomes: intention to speak to boss, self-stigma, worry, perceived severity, illness perceptions, and personal stigma.

RESULTS

A total of 676 participants completed the survey. There was no main effect of diagnostic label on help-seeking intention or stigma outcomes. Intention to speak to a boss was higher with the depression compared to burnout label (MD = 0.40, 95% CI: 0.14-0.66) and perceived severity was higher with the depression label compared to control (MD = 0.48, 95% CI: 0.22-0.74) and all other labels. Those who received the "clinical psychologist" recommendation reported higher help-seeking intention (MD = 0.43, 95% CI: 0.25-0.60) and treatment control (MD = 0.69, 95% CI: 0.29-1.10) compared to the "mind coach" recommendation.

CONCLUSION

Findings highlight the success of efforts to promote help-seeking from clinical psychologists for depression. If burnout is considered a separate diagnostic entity to depression, greater awareness around what such a diagnosis means may be needed. Future research should examine how different terminologies surrounding other mental health conditions impact help-seeking and stigma.

Population Genomic Screening for Genetic Etiologies of Neurodevelopmental/Psychiatric Disorders Demonstrates Personal Utility and Positive Participant Responses

Genomic variants that cause neurodevelopmental/psychiatric disorders (NPD) are relatively prevalent and highly penetrant. This study aimed to understand adults’ immediate responses to receiving NPD-related results to inform inclusion in population-based genomic screening programs. Nine recurrent, pathogenic copy number variants (CNVs) were identified from research exome data, clinically confirmed, and disclosed to adult participants of the Geisinger MyCode Community Health Initiative DiscovEHR cohort by experienced genetic counselors. A subset of in-person genetic counseling sessions (n = 27) were audio-recorded, transcribed, and coded using a grounded theory approach. Participant reactions were overwhelmingly positive and indicated that an NPD genetic etiology was highly valuable and personally useful. Participants frequently reported learning disabilities or other NPD that were not documented in their electronic health records and noted difficulties obtaining support for NPD needs. Most intended to share their genetic result with family members and health care providers and were interested in how their result could improve their healthcare. This study indicates that results from population-based NPD genomic screening can provide personal value for adults with NPD, were viewed positively by participants, and could improve clinical outcomes by informing symptom monitoring for NPD and co-morbidities, promoting improved health behaviors, and enhancing psychotherapeutic approaches.

Understanding the effects of reductionist biological views of eating disorder etiology on patient attitudes and behavior

While eating disorders were historically considered to be a result of psychological or environmental causes, current evidence suggests that eating disorders are the product of complex gene-environment interactions wherein heritable vulnerabilities are activated by multiple exposures to environmental stimuli over the lifespan. Despite the fact that this integrated biopsychosocial etiological view of eating disorders is accepted among many professionals in the eating disorder field, evidence suggests that the general public and some clinicians are susceptible to dualist, or reductionist, views of psychopathology. Currently, little is known about (a) the prevalence of reductionist biological views of eating disorder etiology in those with eating disorders (this view attributes the cause of eating disorders to predominantly biological factors but does not acknowledge psychosocial factors as important contributors), (b) the effects of reductionist biological views on clinical outcomes, and (c) the most effective methods for modifying these views. In this article, we present the results of a preliminary investigation on the relationship between perceived causes of eating disorders and the attitudes and behaviors of those with eating disorders. We then go on to propose specific avenues for further research on uncovering the effects of reductionist biological views of eating disorder etiology.

Above Water: What a game to destigmatise anxiety tells us about developing games targeting sensitive topics (Preprint)

Background

Although in many contexts unsuccessful games targeting learning, social interaction, or behavioral change have few downsides, when covering a sensitive domain such as mental health (MH), care must be taken to avoid harm and stigmatization of people who live with MH conditions. As a result, evaluation of the game to identify benefits and risks is crucial in understanding the game’s success; however, assessment of these apps is often compared with the nongame control condition, resulting in findings specifically regarding entertainment value and user preferences. Research exploring the design process, integrating field experts, and guidelines for designing a successful serious game for sensitive topics is limited.

Objective

The aim of this study is to understand which elements of game design can guide a designer when designing a game for sensitive topics.

Methods

To carefully probe the design space of serious games for MH, we present Above Water (AbW), a game targeting the reduction of stigma surrounding MH, now in its second iteration. The game, AbW, serves as a consistent research probe to solicit expert feedback. Experts were recruited from a range of topic domains related to MH and wellness, game design, and user experience.

Results

By using this deployment as a research probe, this study demonstrates how to synthesize gained insights from multiple expert perspectives and create actionable guidelines for successful design of serious games targeting sensitive topics.

Conclusions

Our work contributes to a better understanding of how to design specialized games to address sensitive topics. We present a set of guidelines for designing games for sensitive subjects, and for each guideline, we present an example of how to apply the finding to the sample game (AbW). Furthermore, we demonstrate the generalizability to other sensitive topics by providing an additional example of a game that could be designed with the presented guidelines.

Psychological correlates of biological and non-biological explanations for stuttering

Purpose: This study examined whether people who stutter would associate biological and non-biological explanations of stuttering with the endorsement of stereotypes about people who stutter, prognostic expectations for the reduction of stuttering, feelings of guilt, self-blame, and shame about stuttering, and agency for speech modification.Method: This was a cross-sectional study including 372 adults who stutter. Participants completed a web survey with scales that measured their agreement with biological and non-biological models of stuttering; their endorsement of common stereotypes for people who stutter; prognostic expectations for reduced stuttering; feelings of guilt, self-blame, and shame about stuttering; and feelings of agency in their ability to modify their speech.Result: Biological explanations for stuttering were significantly correlated with reduced stereotype endorsement about people who stutter, lower prognostic expectations for reducing stuttering, and reduced feelings of guilt and self-blame regarding stuttering. Non-biological explanations for stuttering were significantly correlated with increased endorsement of negative stereotypes about people who stutter, increased prognostic expectations for reducing stuttering, and increased feelings of guilt, self-blame, and shame about stuttering.Conclusion: It is concluded that the implications of biological framing of stuttering among people who stutter are complex and should be well thought out by professionals. Explaining stuttering as biological, but responsive to personal and environmental influences, may lead to reduced guilt and self-blame, while at the same time fostering feelings of agency for speech modification.

Attitudes Towards Seeking Psychological Help: An Integrative Model Based on Contact, Essentialist Beliefs About Mental Illness, and Stigma

Based on intergroup contact theory, a proposed comprehensive model of attitudes towards seeking professional psychological help was tested, including both potential barriers to mental health help-seeking (i.e., public stigma and self-stigma of seeking help, prejudicial and essentialist beliefs about mental illness, intergroup anxiety) and potential facilitators (i.e., direct and extended contact with persons with mental illness). Relevant measures were completed by 119 community-dwelling participants. Path analysis showed that direct (but not extended) contact with mental illness, by reducing intergroup anxiety, led to less negative beliefs about mental illness and weaker essentialist beliefs about mental illness (the latter being directly and positively associated with negative beliefs about mental illness). Moreover, less negative beliefs about mental illness, by reducing perceptions of self (but not public) stigma of seeking psychological help, were related to more positive attitudes towards help-seeking. Results are discussed in the context of the (unintentional) adverse effects of biogenetic (essentialist) explanations of mental disorders, and the clinical implications regarding interventions that aim at improving help-seeking attitudes.

Biological causal beliefs and depression stigma: the moderating effects of first- and second-hand experience with depression

Background: Essentialist theory (ET) links biological attributions for mental illnesses to pessimistic prognostic beliefs and stigma. The commonsense model (CSM) provides a nuanced framework for studying illness beliefs as shaped by experience.Aims: ET-informed hypotheses linking causal and prognostic beliefs and stigmatizing attitudes concerning depression were tested using CSM constructs with a focus on the moderating effects of self-reported experience with this disorder.Methods: U.S. adults (N = 319) completed online questionnaires assessing depression-related beliefs, attitudes and experience. Multiple regression analysis focused on predictive effects of neurobiological and genetic attributions. Potential mediators (prognosis) and moderators (experience) of the biological attribution-stigma link also were tested.Results: Neurobiological attributions predicted viewing depression as more consequential, longer lasting, and unexpectedly, more treatable. Neurobiological attributions were inversely related to stigma, a link partially mediated by beliefs about depression's consequences and duration. However, both biological attributions' relationships to stigma were moderated by experience. Stronger biological attributions predicted less stigma specifically among participants reporting first- or second-hand experience with depression.Conclusion: Experience with depression may shape the relationships of specific causal and prognostic beliefs with depression stigma. Psychoeducation in clinical and public health contexts may be informed by further research using CSM constructs.

Self-Regulation Mindsets: Relationship to Coping, Executive Functioning, and ADHD

Introduction: We examined if mindsets about the stability (fixed mindset) or malleability (growth mindset) of self-regulation predicted coping with setbacks. We also investigated relations with Executive Function (EF) deficits and ADHD status.

Methods: In two correlational studies (Study 1, N = 204; Study 2, N = 184, ADHD, n = 34, Non-ADHD, n = 150), participants reported on their mindsets, self-regulatory abilities, and responded to assessments related to a setback about which they wrote.

Results: Across both studies, growth mindsets predicted less negative affect, greater efficacy, and less avoidant coping. The relationship between mindsets and these responses did not depend on EF deficits (Study 1 and Study 2) nor ADHD diagnostic status (Study 2), but participants with greater EF deficits and an ADHD diagnosis reported weaker growth mindsets of self-regulation.

Discussion: Findings support the evaluation and development of growth mindset interventions to help individuals with disorders of self-regulation to cope more effectively.

Genetic attribution and perceived impact of epilepsy in multiplex epilepsy families

OBJECTIVE

Studies have found that affected individuals who believe the cause of their disorder is genetic may react in various ways, including optimism for improved treatments and pessimism due to perceived permanence of the condition. This study assessed the psychosocial impact of genetic attribution among people with epilepsy.

METHODS

Study participants were 165 persons with epilepsy from multiplex epilepsy families who completed a self-administered survey. Psychosocial impact of epilepsy was assessed with the Impact of Epilepsy Scale, containing items about relationships, employment, overall health, self-esteem, and standard of living. Genetic attribution was assessed using a scale derived from three items asking about the role of genetics in causing epilepsy in the family, the chance of having an epilepsy-related mutation, and the influence of genetics in causing the participant's epilepsy. We estimated prevalence ratios (PRs) for impact of epilepsy above the median using Poisson regression with robust standard errors, adjusting for number of lifetime seizures and time since last seizure.

RESULTS

Participants' age averaged 51 years; 87% were non-Hispanic white, 63% were women, and 54% were college graduates. The genetic attribution scale was significantly associated with having a high impact of epilepsy (adjusted PR = 1.4, 95% confidence interval = 1.07-1.91, P = .02). One of the three genetic attribution questions was also significantly associated with a high impact of epilepsy (belief that genetics had a big role in causing epilepsy in the family, adjusted PR = 1.8).

SIGNIFICANCE

These findings reflect an association between the psychosocial impact of epilepsy and the belief that epilepsy has a genetic cause, among people with epilepsy in families containing multiple affected individuals. This association could arise either because belief in a genetic cause leads to increased psychosocial impacts, or because a greater psychosocial impact of epilepsy leads some to believe their epilepsy is genetic.

Self-rated amygdala activity: an auto-biological index of affective distress

Auto-biological beliefs—beliefs about one’s own biology—are an understudied component of personal identity. Research participants who are led to believe they are biologically vulnerable to affective disorders report more symptoms and less ability to control their mood; however, little is known about the impact of self-originating beliefs about risk for psychopathology, and whether such beliefs correspond to empirically derived estimates of actual vulnerability. Participants in a neuroimaging study (n = 1256) completed self-report measures of affective symptoms, perceived stress, and neuroticism, and an emotional face processing task in the scanner designed to elicit threat responses from the amygdala. A subsample (n = 63) additionally rated their own perceived neural response to threat (i.e., amygdala activity) compared to peers. Self-ratings of neural threat response were uncorrelated with actual threat-related amygdala activity measured via BOLD fMRI. However, self-ratings predicted subjective distress across a variety of self-report measures. In contrast, in the full sample, threat-related amygdala activity was uncorrelated with self-report measures of affective distress. These findings suggest that beliefs about one’s own biological threat response—while unrelated to measured neural activation—may be informative indicators of psychological functioning.

Mindsets of Addiction: Implications for Treatment Intentions

Introduction: The goal of the current work is to contribute to the critical dialog regarding consequences of different communications about the nature of addiction by offering a new theoretical approach. Specifically, we merge a mindset perspective, which highlights the importance of beliefs regarding the malleability of human attributes, with the attribution literature to explore how messages stressing the changeable vs. fixed nature of addiction influence beliefs and treatment intentions.

Method: We crafted a message about addiction designed to induce the belief in the potential to change without influencing self-blame (compensatory-growth mindset message) and compared it to a message focused on the fixed underpinnings of addiction (disease-fixed mindset message).

Results: In an online sample of probable substance users (N = 214), we found that the compensatory-growth, relative to the disease-fixed message, led to participants reporting stronger growth mindsets and efficacy without an impact on blame. Additionally, the compensatory-growth, relative to the disease-fixed message, led to stronger intentions to pursue counseling and cognitive behavioral treatment therapies.

Discussion: The current work finds support for an innovative theoretical approach for understanding motivation to seek treatment among individuals with probable substance use problems.

Perceptions of ADHD Among Diagnosed Children and Their Parents: A Systematic Review Using the Common-Sense Model of Illness Representations

Research on children and parents' experiences of ADHD has grown in recent years, attracting attention to their subjective perception of ADHD as a disorder. Theoretical accounts of illness perception suggest that it is multi-dimensional, consisting of at least five core constructs (see the common-sense model of illness representations or CSM: Leventhal et al., in: Rachman (ed) Medical psychology, Pergamon, New York, vol 2, pp 7-30, 1980, in: Baum, Taylor, Singer (eds) Handbook of psychology and health: social psychological aspects of health, Earlbaum, Hillsdale, vol 4, pp 219-252, 1984). We suggest that the application of CSM in children/adolescents with ADHD and their parents may play an important role in understanding their coping behavior, treatment adherence, and emotional well-being. A systematic search identified 101 eligible studies that investigated the perception of ADHD among diagnosed children/adolescents and their parents. In general, these studies support the existence of the multiple facets of illness representations proposed by the CSM in both diagnosed youngsters and parents indicating substantial variability among both parents and youngsters on each of these facets. The comprehensive assessment of the representations of ADHD indicates imbalance attention to the different representations of ADHD in the literature; disproportional research attention has been paid to the perceived effectiveness of treatment (i.e., treatment control dimension) compared to other illness representations (e.g., timeline, consequence, and coherence), despite research showing their relevance to treatment adherence among other implications. The review identifies the limitation of existing relevant research, needed foci for future studies, specific testable hypotheses, and potential clinical implications of the multifaceted representations of ADHD among youngsters and carers alike.

Impact of causal explanations for social anxiety disorder on stigma and treatment perceptions

Background and aims: There is evidence to suggest that biogenetic explanations for symptoms of mental disorders have become increasingly popular. Research suggests that such explanations provokes mixed blessings: biological explanations may reduce blame but also encourage prognostic pessimism and promote perceptions of pharmacological treatment over psychotherapy. The goal of this study was to evaluate the impact of different causal explanations on social anxiety disorder.Method: About 205 adults completed an experiment where they read a vignette describing an individual with social anxiety disorder and were randomly assigned to a symptom explanation that was: (1) biological, (2) biopsychosocial, (3) psychosocial, or (4) no explanation.Results: The psychosocial condition yielded the highest perceived credibility and lowest attributions of blame. The biological condition promoted positive expectations for medication effectiveness compared to other conditions. Conditions did not differ on prognostic expectations.Conclusions: Calls attention to the risk of generalizing from previous research to mental disorders as a whole.

Biomedical Explanations of Psychopathology and Their Implications for Attitudes and Beliefs About Mental Disorders

Mental disorders are increasingly conceptualized as biomedical diseases, explained as manifestations of genetic and neurobiological abnormalities. Here, we discuss changes in the dominant explanatory accounts of psychopathology that have occurred over time and the driving forces behind these shifts, lay out some real-world evidence for the increasing ascendancy of biomedical explanations, and provide an overview of the types of attitudes and beliefs that may be affected by them. We examine theoretical and conceptual models that are relevant to understanding how biomedical conceptualizations might affect attitudes and beliefs about mental disorders, and we review some empirical evidence that bears on this question. Finally, we examine possible strategies for combatting potential negative effects of biomedical explanations and discuss important conclusions and directions for future research.

The Burden of Stigma on Health and Well-Being: A Taxonomy of Concealment, Course, Disruptiveness, Aesthetics, Origin, and Peril Across 93 Stigmas

Most individuals are stigmatized at some point. However, research often examines stigmas separately, thus underestimating the overall impact of stigma and precluding comparisons across stigmatized identities and conditions. In their classic text, Social Stigma: The Psychology of Marked Relationships, Edward Jones and colleagues laid the groundwork for unifying the study of different stigmas by considering the shared dimensional features of stigmas: aesthetics, concealability, course, disruptiveness, origin, peril. Despite the prominence of this framework, no study has documented the extent to which stigmas differ along these dimensions, and the implications of this variation for health and well-being. We reinvigorated this framework to spur a comprehensive account of stigma's impact by classifying 93 stigmas along these dimensions. With the input of expert and general public raters, we then located these stigmas in a six-dimensional space and created discrete clusters organized around these dimensions. Next, we linked this taxonomy to health and stigma-related mechanisms. This quantitative taxonomy offers parsimonious insights into the relationship among the numerous qualities of numerous stigmas and health.

Illness perceptions and adherence in bipolar disorder: An exploratory study

BACKGROUND

According to the Self-Regulation Model, illness perceptions influence an individual's coping (such as the taking of treatment) and emotional response to their illness. Emerging research suggests that this model could be used to explore illness perceptions in mental health. The aim of this exploratory study is, firstly, to measure and describe illness perception in French patients with a bipolar diagnosis and, secondly, to explore associations between illness perceptions and adherence in this population.

METHOD

Thirty-eight French patients with bipolar disorder completed the Illness Perception Questionnaire for Schizophrenia (except the identity dimension). We measured medication adherence with the Medication Adherence Rating Scale.

RESULTS

Our results showed that patients with high perceptions concerning treatment control, low perceptions of negative emotions of their mental illness, low perception of consequences and high comprehension of their disorder had a better adherence.

CONCLUSIONS

Illness perceptions can provide a framework for understanding adherence in bipolar disorder, and the findings could have important clinical and research implications.

Communicating the Neuroscience of Psychopathy and Its Influence on Moral Behavior: Protocol of Two Experimental Studies

Neuroscience has identified brain structures and functions that correlate with psychopathic tendencies. Since psychopathic traits can be traced back to physical neural attributes, it has been argued that psychopaths are not truly responsible for their actions and therefore should not be blamed for their psychopathic behaviors. This experimental research aims to evaluate what effect communicating this theory of psychopathy has on the moral behavior of lay people. If psychopathy is blamed on the brain, people may feel less morally responsible for their own psychopathic tendencies and therefore may be more likely to display those tendencies. An online study will provide participants with false feedback about their psychopathic traits supposedly based on their digital footprint (i.e., Facebook likes), thus classifying them as having either above-average or below-average psychopathic traits and describing psychopathy in cognitive or neurobiological terms. This particular study will assess the extent to which lay people are influenced by feedback regarding their psychopathic traits, and how this might affect their moral behavior in online tasks. Public recognition of these potential negative consequences of neuroscience communication will also be assessed. A field study using the lost letter technique will be conducted to examine lay people's endorsement of neurobiological, as compared to cognitive, explanations of criminal behavior. This field and online experimental research could inform the future communication of neuroscience to the public in a way that is sensitive to the potential negative consequences of communicating such science. In particular, this research may have implications for the future means by which neurobiological predictors of offending can be safely communicated to offenders.

Psychiatric Genetics in Child Custody Proceedings: Ethical, Legal, and Social Issues

This paper considers the ethical, legal, and social issues raised by the prospect of increasing use of psychiatric genetic data in child custody litigation. Although genetic tests cannot currently confirm a parent or child's psychiatric diagnosis, it is likely that as relevant findings emerge, they will be introduced in family courts to challenge parental capacity. Here, we draw on three projected, but plausible, scenarios for obtaining psychiatric data about parents -- imposed genetic testing, access to medical records, and genetic theft -- then consider the use of psychiatric genetic data of children, to highlight the issues that judges, child custody evaluators, and clinicians who may provide treatment for parents or children with mental health issues will need to consider. These include: genetic privacy, stigma, genetic surveillance, and judicial and health professionals' bias. We argue that the unchecked introduction of psychiatric genetic data may have a detrimental effect on the administration of justice. In particular, the article highlights the risk that the (mis)use of psychiatric genetic data in custody disputes would 1) exacerbate stigma and treatment-avoidance among parents and incentivize privacy violations to pressure parents to relinquish parental rights; 2) disproportionately affect poor parents and single mothers of color involved with Child Protective Services; and 3) detract attention from social and environmental factors impacting mental health to the detriment of the families involved. Awareness of these issues and an understanding of the meaning of genomic data by judges and custody evaluators will be pivotal in ensuring that justice is served.

Depression and genetic causal attribution of epilepsy in multiplex epilepsy families

OBJECTIVES

Rapid advances in genetic research and increased use of genetic testing have increased the emphasis on genetic causes of epilepsy in patient encounters. Research in other disorders suggests that genetic causal attributions can influence patients' psychological responses and coping strategies, but little is known about how epilepsy patients and their relatives will respond to genetic attributions of epilepsy. We investigated the possibility that among members of families containing multiple individuals with epilepsy, depression, the most frequent psychiatric comorbidity in the epilepsies, might be related to the perception that epilepsy has a genetic cause.

METHODS

A self-administered survey was completed by 417 individuals in 104 families averaging 4 individuals with epilepsy per family. Current depression was measured with the Patient Health Questionnaire. Genetic causal attribution was assessed by three questions addressing the following: perceived likelihood of having an epilepsy-related mutation, perceived role of genetics in causing epilepsy in the family, and (in individuals with epilepsy) perceived influence of genetics in causing the individual's epilepsy. Relatives without epilepsy were asked about their perceived chance of developing epilepsy in the future, compared with the average person.

RESULTS

Prevalence of current depression was 14.8% in 182 individuals with epilepsy, 6.5% in 184 biologic relatives without epilepsy, and 3.9% in 51 individuals married into the families. Among individuals with epilepsy, depression was unrelated to genetic attribution. Among biologic relatives without epilepsy, however, prevalence of depression increased with increasing perceived chance of having an epilepsy-related mutation (p = 0.02). This association was not mediated by perceived future epilepsy risk among relatives without epilepsy.

SIGNIFICANCE

Depression is associated with perceived likelihood of carrying an epilepsy-related mutation among individuals without epilepsy in families containing multiple affected individuals. This association should be considered when addressing mental health issues in such families.

Neuroessentialism: Theoretical and Clinical Considerations

Neuroessentialism is the view that the definitive way of explaining human psychological experience is by reference to the brain and its activity. This leads to the view that psychological disorders, such as depression, are fundamentally brain disorders. Neuroessentialism has grown increasingly popular for academic and public audiences. It has also attracted critics. This article describes neuroessentialism, the reasons for its rising prominence, and the theoretical and clinical concerns it raises. It connects these concerns to evidence from empirical studies that suggest that neuroessentialistic conceptualization of depression can have negative clinical impacts that need to be considered by mental health professionals.

Sometimes more competent, but always less warm: Perceptions of biologically oriented mental-health clinicians

BACKGROUND AND AIMS

Biological conceptualizations of psychopathology are ascendant, including among mental-health clinicians. However, it is unknown how this might affect people's perceptions of clinicians, which in turn could have considerable public-health implications. The present studies sought to address this issue.

METHODS

In the present research, participants imagined that they or their loved ones were suffering from a mental disorder and then rated their perceptions of one clinician espousing the view that 'mental disorders are brain diseases' and another describing them as 'disorders of thoughts and emotions'.

RESULTS

Biologically oriented clinicians were perceived as more competent and effective only when the disorder in question was judged to be biologically caused. Otherwise, there was no significant difference in perceived competence, and biologically oriented clinicians were rated less effective. Regardless, all participants perceived the biologically oriented clinician as significantly less warm on average than the psychosocially oriented clinician.

CONCLUSION

These findings may have important clinical implications for the crucial therapeutic alliance between therapists and patients.

Biogenetic Explanations of Mental Disorder

Biogenetic explanations of mental disorder are increasingly prominent. However, they have decidedly mixed implications for how affected persons are perceived. We review evidence of these mixed blessings from three perspectives: how people with mental disorders are viewed by the public, by themselves, and by clinicians. Although biogenetic explanations may soften public stigma by diminishing blame, they increase it by inducing pessimism, avoidance, and the belief that affected people are dangerous and unpredictable. These explanations may also induce pessimism and helplessness among affected people and reduce the empathy their treating clinicians feel for them. We interpret these findings in light of social psychology research on essentialist and mechanistic thinking.

Beliefs of people taking antidepressants about the causes of their own depression

BACKGROUND

The beliefs of people receiving treatment about the causes of their own mental health problems are researched less often than the causal beliefs of the public, but have important implications for relationships with prescribers, treatment choices and recovery.

METHOD

An online survey on a range of beliefs about depression, and experiences with antidepressants, was completed by 1829 New Zealand adults prescribed anti-depressants in the preceding five years, 97.4% of whom proceeded to take antidepressants.

RESULTS

Six of 17 beliefs about the causes of their own depression were endorsed by more than half the sample: chemical imbalance, family stress, work stress, heredity, relationship problems and distressing events in childhood. There were some marked differences in content, structure and level of conviction of beliefs about one׳s own depression and the sample׳s previously published beliefs about depression in general. There were also significant differences between the beliefs of demographic groupings. Regression analyses revealed that self-reported effectiveness of the antidepressants was positively associated with bio-genetic causal beliefs. The quality of the relationship with the prescribing doctor was positively related to a belief in chemical imbalance as a cause and negatively related to a belief in unemployment as a cause.

LIMITATIONS

The convenience sample may have been biased towards a favourable view of bio-genetic explanations, since 83% reported that the medication reduced their depression.

CONCLUSIONS

People experiencing depression hold complex, multifactorial and idiosyncratic sets of beliefs about the causes of their own depression, apparently based at least in part on their own life experiences and circumstances. Exploring those beliefs may enhance the doctor-patient relationship and selection of appropriate treatment modality.

Effects of biological explanations for mental disorders on clinicians' empathy

Mental disorders are increasingly understood in terms of biological mechanisms. We examined how such biological explanations of patients' symptoms would affect mental health clinicians' empathy--a crucial component of the relationship between treatment-providers and patients--as well as their clinical judgments and recommendations. In a series of studies, US clinicians read descriptions of potential patients whose symptoms were explained using either biological or psychosocial information. Biological explanations have been thought to make patients appear less accountable for their disorders, which could increase clinicians' empathy. To the contrary, biological explanations evoked significantly less empathy. These results are consistent with other research and theory that has suggested that biological accounts of psychopathology can exacerbate perceptions of patients as abnormal, distinct from the rest of the population, meriting social exclusion, and even less than fully human. Although the ongoing shift toward biomedical conceptualizations has many benefits, our results reveal unintended negative consequences.

Beliefs of people taking antidepressants about causes of depression and reasons for increased prescribing rates

BACKGROUND

Public beliefs about the causes of mental health problems are related to desire for distance and pessimism about recovery, and are therefore frequently studied. The beliefs of people receiving treatment are researched less often.

METHOD

An online survey on causal beliefs about depression and experiences with antidepressants was completed by 1829 New Zealand adults prescribed anti-depressants in the preceding five years, 97.4% of whom proceeded to take antidepressants.

RESULTS

The most frequently endorsed of 17 causal beliefs were family stress, relationship problems, loss of loved one, financial problems, isolation, and abuse or neglect in childhood. Factor analysis produced three factors: 'bio-genetic', 'adulthood stress' and 'childhood adversity'. The most strongly endorsed explanations for increases in antidepressant prescribing invoked improved identification, reduced stigma and drug company marketing. The least strongly endorsed was 'Anti-depressants are the best treatment'. Regression analyses revealed that self-reported efficacy of the antidepressants was positively associated with bio-genetic causal beliefs, negatively associated with childhood adversity beliefs and unrelated to adulthood stress beliefs. The belief that 'People cannot׳ get better by themselves even if they try' was positively associated with bio-genetic beliefs.

LIMITATIONS

The convenience sample may have been biased towards a favourable view of bio-genetic explanations, since 83% reported that the medication reduced their depression.

CONCLUSIONS

Clinicians׳ should consider exploring patients׳ causal beliefs. The public, even when taking antidepressants, continues to hold a multi-factorial causal model of depression with a primary emphasis on psycho-social causes. A three factor model of those beliefs may lead to more sophisticated understandings of relationships with stigma variables.