Framing depression as a functional signal, not a disease: Rationale and initial randomized controlled trial 2023 Schroder et al

[Andy]

Abstract

Depression is often framed as a disease or dysfunctional syndrome, yet this framing has unintended negative consequences including increased stigma. Here, we consider an alternative messaging framework – that depression serves an adaptive function. We describe the historical development of popular messages about depression and draw from the fields of evolutionary psychiatry and social cognition to describe the alternative framework that depression is a “signal” that serves a purpose.

We then present data from a pre-registered, online randomized-controlled study in which participants with self-reported depression histories viewed a series of videos that explained depression as a “disease like any other” with known biopsychosocial risk factors (BPS condition), or as a signal that serves an adaptive function (Signal condition).

In the entire sample (N = 877), three of the six hypotheses were supported: The Signal condition led to less self-stigma, greater offset efficacy, and more adaptive beliefs about depression. Exploratory analyses revealed these Signal effects were stronger among females (N = 553), who also showed a greater growth mindset of depression after the Signal explanation. Results suggest that framing depression as an adaptive signal can benefit patients and avoid harmful consequences of popular etiological presentations.

We conclude that alternative framings of depression are worthy of further study.

Paywalled but introduction and section snippets are available, https://www.sciencedirect.com/science/article/abs/pii/S0277953623003520

 

[InitialConditions]

Personally, I don't think we should be using unproven hypotheses to explain illnesses to patients. We had this with the dysregulation model stuff for ME/CFS back in late 2021. I happen to think it matters whether the explaination is true (or not)!

 

[Creekside]

Oooh, maybe writing "depression" in different fonts would help patients!

 

[rvallee]

This is impressively ridiculous, no less for the fact that it is precisely this demedicalization that frames it as unimportant to MDs and is the main source of discrimination. Again they are merely recounting what they did, then framing it as if it basically makes it fact. This is a very good parody of science.

No one knows what depression is, if it's even one thing rather than many. No one can differentiate it from other things and no one has a damn clue what the cause is. Quit making stuff up, it's definitely not the way out of having made stuff up for decades.

Agree with @Creekside, if you only use papyrus it makes all the fears and worries go away. It's not even half silly as this sorry excuse for a jobs program.

 

[ToneAl]

We have had a lot of theories regarding depression over the years like the chemical imbalance, wrong thoughts to this. So is this the long line of theories that can never be proven

 

[Hutan]

The idea, taken at its most literal, is, I think, ok. 'Depression', whatever that may be in practice for a particular person, is a symptom that needs some attention. It is indeed a signal, as is any symptom.

For some people, experiencing 'depression' might mean that they should change something in their life, perhaps seeking support from loved ones and others to do so. This might apply where depression is actually sadness and/or grief, that is, reactive depression, to environmental or social circumstances. It might be a reaction to the difficulty of a relentless physical problem, pain or nausea for example, or to a diagnosis with a terminal disease, and the impact of those things on quality of life.

For other people, what has been labelled as depression might actually be a direct symptom of a disease. And so they should be given a range of investigations, to find out what is going on.

I am a lot more comfortable with the framing of 'depression' as a symptom, a signal of something needing attention, than as a disease. I think it's a lot like fatigue, and chronic pain too, in that respect. I think it's good to get away from all 'depression' being described as a disease with a standard treatment pathway. The BPS people have tried to label chronic (primary) pain as a disease rather than a symptom and a useful signal. That's been very unhelpful when it comes to people actually getting help to work out the source of the pain and how to deal with it.

The Signal condition led to less self-stigma, greater offset efficacy, and more adaptive beliefs about depression.

I think the idea does encourage more efficacy and adaptive beliefs, including from medical professionals. It encourages finding the problem, and then responding to that, rather than a one-size fits all 'talking therapy to work what your parents did wrong and a large helping of anti-depressant medication'.

Results suggest that framing depression as an adaptive signal can benefit patients and avoid harmful consequences of popular etiological presentations.

Of course, it depends how the idea is implemented. But, I'm glad that these authors recognise that the current BPS framing with its focus on maladaptive personalities does have harmful consequences.

 

[Creekside]

I bring you ... GFT! Graduated font therapy! The patient starts with depressing fonts, and gradually works up to more cheerful fonts, resulting in a return to happiness! Sign up today!!!