The same, but different: Understanding responsibility attributions for depression with a cross-national survey in the...

Understanding how the population attributes responsibility for depression is crucial for shaping the treatment of depressed individuals in society and influencing support for health-related policies. International findings suggest that responsibility attributions generally differ between countries and cultures. However, it is unknown whether they also differ between different healthcare systems within individualistic cultures. To address this research gap, we compared different responsibility attributions for depression (individual, genetic, social) in the United States (individual-based healthcare system) and Germany (solidarity-based healthcare system) in a cross-sectional online survey with 2,168 participants. Additionally, we examined factors associated with these attributions in both countries, including the use of health information sources such as alternative and social media, since media use - and the media frames conveyed through it - is linked to responsibility attributions. Results show that social context-attributions were most prevalent in both countries, but significantly more pronounced in Germany. In contrast, individual and genetic responsibility attributions were higher in the U.S. In both samples, the use of alternative media for health information-seeking was positively associated with individual attributions, while depression knowledge was linked to greater social and genetic attributions. Healthism attitudes were positively related to all three types of responsibility attributions.