Stressors and chemical imbalances: Beliefs about the causes of depression in an acute psychiatric treatment sample

J Affect Disord. 2020 Nov 1;276:537-545. doi: 10.1016/j.jad.2020.07.061. Epub 2020 Jul 19.


Background: Public perceptions of mental illness are increasingly construed in neurobiological and genetic terms. Accumulating evidence suggests there are some unintended consequences of these explanations, including reduced optimism for recovery among individuals with depression. However, little is known about how these beliefs relate to treatment process and outcomes in a psychiatric treatment setting, a gap this study aimed to fill.

Methods: We examined etiological beliefs about depression in a sample of patients (N = 279) seeking acute treatment in a behaviorally-based therapy program at a psychiatric hospital and examined relations with treatment expectations and outcomes.

Results: We found that although psychosocial explanations of depression were most popular, biogenetic beliefs, particularly the belief that depression is caused by a chemical imbalance, were prevalent in this sample. Further, the chemical imbalance belief related to poorer treatment expectations. This relationship was moderated by symptoms of depression, with more depressed individuals showing a stronger relationship between chemical imbalance beliefs and lower treatment expectations. Finally, the chemical imbalance belief predicted more depressive symptoms after the treatment program ended for a 2-week measure of depression (but not for a 24-hour measure of depression), controlling for psychiatric symptoms at admission, inpatient hospitalizations, and treatment expectations.

Limitations: The sample was homogenous in terms of race and ethnicity and we did not assess how patients came to their beliefs.

Conclusions: Together, the results illustrate the correlates and possible impacts of etiological beliefs in a real-world clinical setting and invite a critical discussion about predominant messages about the etiology of depression.

Keywords: Chemical imbalance; Depression; Etiological beliefs; Treatment expectancy.

MeSH terms

  • Depression* / etiology
  • Humans
  • Mental Disorders*
  • Optimism
  • Psychotherapy
  • Surveys and Questionnaires