A new study published in Social Science & Medicine suggests that framing depression as a “signal” with functional value, rather than solely a disease, could be beneficial for those experiencing it. Researchers found that those who viewed depression through this “signal” lens reported lower self-stigma and stronger beliefs in the adaptiveness and manageability of their condition.
Traditionally, depression has been viewed through a disease-based lens, attributed to genetic, biological, or chemical imbalances. This biogenetic explanation, while reducing self-blame, has also led to unintended negative consequences like increased stigma and reduced hope for recovery.
The researchers proposed a new way of looking at depression: as a signal indicating that something in one’s life needs more attention. This approach draws from evolutionary psychiatry and suggests that, like fear or sadness, depression could have an adaptive function.
“My research focuses on how people think and talk about depression. Biological explanations (e.g., the ‘chemical imbalance’ narrative) have been around for a long time now but research is showing that these messages can actually have negative consequences for people who are trying to get better,” said study author Hans S. Schroder, a clinical assistant professor of psychiatry at the University of Michigan Medical School.
“So we’re testing out different explanations of depression beyond this disease-centered framework. I’ve been interested in the idea that depression actually has a purpose in one’s life – that it’s trying to tell you something isn’t working for you right now and you can get curious about your life in order to address the depression.”
The researchers conducted a pre-registered, randomized-controlled, online study to evaluated the impact of framing depression either as a disease or as a functional signal.
The study included 877 adults in the United States who self-reported a history of depression but had not engaged in extensive treatment. This specific inclusion criterion was chosen to focus on individuals whose perceptions of depression were less likely to be influenced by prior clinical interventions. The researchers utilized Dynata, an online market research firm, for recruitment, aiming to closely mirror the racial and ethnic composition of the U.S. population, based on census data.
The participants were randomly assigned to one of two conditions. In the Biopsychosocial Risk Factor condition, depression was introduced as a disease, akin to cancer or diabetes, with a focus on its behavioral, environmental, and biological risk factors. In the signal condition, participants were presented with the notion that depression could serve an adaptive function, signaling the need for greater attention to certain areas of life.
The core of the intervention consisted of a series of videos designed to introduce participants to these differing perspectives. The content was carefully crafted to ensure consistency in delivery, length, and complexity across conditions, minimizing potential biases. Importantly, both conditions included messages designed to absolve participants of personal fault for their depression.
Participants in the signal condition reported lower self-stigma (“I avoid interacting with others because I am a person with mental illness”) and more adaptive beliefs about depression (“Experiencing depression can lead to new insights”) than those in the Biopsychosocial Risk Factor condition. This finding suggests that viewing depression as a functional signal, rather than a disease, could help alleviate some of the negative self-perceptions associated with mental health issues.
“We found that even though the two explanations were matched very closely in terms of talking about depression, the signal framework was more beneficial in terms of stigma, suggesting that talking about depression as having a function can be beneficial,” Schroder told PsyPost.
Additionally, the study found that the signal condition was associated with an increase in what the researchers termed “offset efficacy” — the belief in one’s agency and ability to overcome depression. This increase was observed despite the condition not significantly altering participants’ sense of personal responsibility for their depression.
“There are many different ways to think about depression, not just one way,” Schroder said. “And our study shows that for some folks, thinking that depression has a ‘purpose’ – it’s your body’s way of telling you something needs more attention in your life – has benefits in terms of stigma and hope for recovery.”
However, the study did not find significant differences between the two conditions in terms of treatment-seeking attitudes. This outcome indicates that while the functional signal framing can positively impact stigma and beliefs about depression’s malleability, it does not necessarily translate to a greater inclination to seek treatment.
Interestingly, the researchers also uncovered gender differences in the effects of the signal framing. While the positive impacts of this framing were observed across the general participant pool, they were particularly pronounced among female participants.
This study opens new avenues for how we understand and approach depression. Viewing depression as a signal rather than a dysfunction could lead to more nuanced public health campaigns and treatment approaches that focus on addressing life’s challenges.
But the study’s focus on treatment-naïve individuals limits generalizability to those already in treatment. In addition, the effects observed were immediate, and the long-term impact remains unknown.
“This was our first study on ‘signal framing’ and as such we used a sample of people who used an online marketing platform that had never had any treatment before,” Schroder noted. “So we can’t generalize our findings beyond that sample quite yet. We also don’t know the long-term consequences of the signal framing just yet as this was a one-time study.”
“We really hope to be able to continue to find out ‘what message works best for which person’ in terms of thinking and talking about depression. Some people find the signal framework really motivating to work on their depression whereas others find other explanations more helpful.”
The study, “Framing depression as a functional signal, not a disease: Rationale and initial randomized controlled trial,” was authored by Hans S. Schroder, Andrew Devendor, and Brian J. Zikmund-Fisher.
