Medical providers and biogenetic messages about depression: A vignette experiment

Healthcare providers play an important role in educating patients about the causes of their problems. Certain narratives, such as the chemical imbalance explanation of depression, are overly simplistic and may decrease hope for recovery and increase stigma by triggering cognitive biases about the perceived permanence of biological causes. However, no previous studies have surveyed medical providers on their use of biogenetic messaging (messages that imply a biological, chemical, or genetic cause) to patients, nor has any research studied the conditions under which these messages are more likely to be invoked.

In this online, pre-registered vignette experiment, we randomized 396 medical providers (physicians and medical students) to read one of two vignettes of a woman experiencing significant depressive symptoms: one in which her depression was precipitated by a significant loss (Trigger condition) and one in which no clear cause for depression was provided (No-trigger condition). We hypothesized that the no-trigger condition would lead to H1) more biogenetic language communicated to the patient and H2) more recommendations for medication and hospitalization. H3 predicted that pre-manipulation biogenetic beliefs would correlate with medication recommendations.

In line with hypothesis H1, providers exposed to the "no-trigger" vignette were more likely to focus their conversation using biogenetic language. However, Hypotheses 2 and 3 were unsupported - participants in the "no-trigger" condition were no more likely to recommend medication or hospitalization (H2) and pre-manipulation beliefs did not correlate with treatment recommendations (H3). Exploratory analyses revealed that the tendency to use biogenetic language was correlated with efforts to reduce patient blame.

Healthcare providers are more likely to use biogenetic narratives when the cause of a patient's depression is unclear.

Clinicians should be mindful of the lure of biogenetic messaging, especially when the cause of depression is unclear and they want to reduce blame.